MEDICARE: GINA ANN HALDEMAN PT, 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	PT008162	GA

General Provider Information

NPI Number	:	1710203740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA ANN HALDEMAN PT, DPT

Provider Business Mailing Address
First Line	:	99 WAVERLY LN
Second Line	:
City	:	RICHMOND HILL
State	:	GA
Zip	:	31324-7805
Country	:	US
Telephone Number	:	404-803-0679
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 HWY 80
Second Line	:
City	:	BLOOMINGDALE
State	:	GA
Zip	:	31302
Country	:	US
Telephone Number	:	812-421-0140
Fax Number	:

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

Provider Enumeration Date	:	04/15/2010
Last Update Date	:	11/03/2025

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