Active NPI
Ginna Lorraine Bouali
- Physical Therapy Assistant
- Deltona, FL
National Provider Identifier
1720238140
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA 21423
- Practice address
- 1565 Saxon Blvd Ste 301
Deltona, FL 32725-5836 - Phone
- (386) 851-0901
- Fax
- (386) 851-2426
- NPI assigned
- Sep 22, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | PTA 21423 | FL | Primary |
Addresses
Primary practice location
1565 Saxon Blvd Ste 301
Deltona, FL 32725-5836
Mailing address
107 Belchase CT
Debary, FL 32713-2209
Phone (407) 489-0785
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA 21423 | FL | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1222041600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1222041600000",
"number": "1720238140",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "107 BELCHASE CT",
"city": "DEBARY",
"state": "FL",
"postal_code": "327132209",
"telephone_number": "407-489-0785"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1565 SAXON BLVD STE 301",
"city": "DELTONA",
"state": "FL",
"postal_code": "327255836",
"telephone_number": "386-851-0901",
"fax_number": "386-851-2426"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUALI",
"first_name": "GINNA",
"middle_name": "LORRAINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-09-22",
"last_updated": "2008-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "FL",
"license": "PTA 21423",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Deltona, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.