MEDICARE: GINA ALICIA PIERETTI DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5646	OR

General Provider Information

NPI Number	:	1033378112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA ALICIA PIERETTI DPT

Provider Business Mailing Address
First Line	:	120 N EVEREST RD STE C
Second Line	:
City	:	NEWBERG
State	:	OR
Zip	:	97132-2116
Country	:	US
Telephone Number	:	503-538-8952
Fax Number	:	503-537-2027

Provider Business Practice Location Address
First Line	:	120 N EVEREST RD STE C
Second Line	:
City	:	NEWBERG
State	:	OR
Zip	:	97132-2116
Country	:	US
Telephone Number	:	503-538-8952
Fax Number	:	503-537-2027

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2008
Last Update Date	:	06/24/2008

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