Doctor Name: | GINA MARIE DEBERNARDO |
NPI Number: | 1407047285 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | MA30379 |
Business Practice Address: | 713 Pine Forest Trl E Port Orange, FL - 321274872 |
Business Phone Number: | 3864050588 |
Business Fax Number: | |
Mailing Address: | 713 Pine Forest Trl E, PORT ORANGE |
State: | FL |
Postal Code: | 321274872 |
Phone Number: | 3864050588 |
Fax Number: | |
NPI Enumeration Date: | 08/06/2007 |
NPI Last Update Date: | 01/22/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | MA30379 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |