MEDICARE: MRS. GEMMA LORNA DAQUIPA MAHINAY PT

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	05007883A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467659615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GEMMA LORNA DAQUIPA MAHINAY PT

Provider Business Mailing Address
First Line	:	3325 YALE DR
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47711-7305
Country	:	US
Telephone Number	:	502-552-1422
Fax Number	:

Provider Business Practice Location Address
First Line	:	1282 MAIN ST
Second Line	:
City	:	MOUNT VERNON
State	:	IN
Zip	:	47620-1365
Country	:	US
Telephone Number	:	812-307-1089
Fax Number	:	812-307-1177

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

Provider Enumeration Date	:	06/29/2007
Last Update Date	:	03/15/2017

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