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General NPI Number Information
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NPI Number | 1881940757
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Entity Type | Individual
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Provider Name | GINA MARIE FEMINO PTA
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Gender | Female
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Dates
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Enumeration Date | 07/30/2012
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Last Update Date | 07/30/2012
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Provider Practice Location Address
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Address Line | 524 CLEVELAND BLVD STE 110
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City | CALDWELL
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State | ID
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Zip | 83605-4079
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Country | US
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Telephone | 208-455-5010
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Fax | 208-455-5020
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Provider Business Mailing Address
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Address Line | 6032 N GADWALL LN
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City | BOISE
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State | ID
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Zip | 83714-1284
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Country | US
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Telephone | 208-484-0143
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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 | PTA-3051
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License Number State | ID
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