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General NPI Number Information
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NPI Number | 1356571210
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Entity Type | Individual
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Provider Name | GINA GERONA LPTA,ATC,LMT
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Gender | Female
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Dates
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Enumeration Date | 07/24/2009
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Last Update Date | 07/24/2009
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Provider Practice Location Address
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Address Line | 2802 PARENTAL HOME RD
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City | JACKSONVILLE
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State | FL
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Zip | 32216-5702
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Country | US
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Telephone | 352-721-0088
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Fax |
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Provider Business Mailing Address
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Address Line | 2802 PARENTAL HOME RD
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City | JACKSONVILLE
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State | FL
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Zip | 32216-5702
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Country | US
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Telephone | 352-721-0088
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA17603
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AL2168
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA55451
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License Number State | FL
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