Provider Demographics
NPI:1043868896
Name:OKERSON, GINA (PTA)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:OKERSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2334 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6208
Mailing Address - Country:US
Mailing Address - Phone:559-770-5509
Mailing Address - Fax:
Practice Address - Street 1:1823 SHAW AVE STE 101
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-4064
Practice Address - Country:US
Practice Address - Phone:559-298-9120
Practice Address - Fax:559-298-0822
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50220225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant