Individual provider Active NPI

Gina Nguyen

  • Physical Therapist
  • St Petersburg, FL
National Provider Identifier
1962013276
Registry record updated Mar 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT36790 Issued in FL
Practice address
4020 Park St N Ste 101
St Petersburg, FL 33709-4030
Phone
(727) 388-4688
Fax
(727) 388-6887
NPI assigned
Aug 11, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 30, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT36790 FL Primary

Addresses

Primary practice location

4020 Park St N Ste 101
St Petersburg, FL 33709-4030

Mailing address

1412 S Madison Ave
Clearwater, FL 33756-2246
Phone (850) 341-0779

Other practice location 1

25241 Elementary Way Ste 200
Bonita Springs, FL 34135-7883
Phone (239) 947-4184

Other practice location 2

10676 Colonial Blvd Ste 50
Fort Myers, FL 33913-8715
Phone (239) 465-4880

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210407001795 FL Practitioner - Physical Therapist in Private Practice 3274940309 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
83.26 of 100Reported as group
Quality
86.58
Improvement activities
40
Cost
68.79

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT36790FLMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Sobe Innovative Rehabilitation PLLC Physical Therapist CurrentSince May 8, 2024 Accepting new patients
Hays S Estes DPT PLLC Physical Therapist CurrentSince Feb 9, 2021 Accepting new patients
Fyzbiz, LLC Physical Therapist PastSince Aug 1, 2022 Accepting new patients
Douglass Orthopedic & Spine Rehabilitation, Inc. Physical Therapist PastSince Jul 1, 2001 Accepting new patients

Locations

2777 NE 183rd St
Aventura, FL 33160
Phone (305) 405-2014

1661 Rainbow Dr
Clearwater, FL 33755
Phone (727) 442-7500

Networks

  • Optimum HealthCare HMO Network

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1597104000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680134400000",
    "number": "1962013276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1412 S MADISON AVE",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337562246",
            "telephone_number": "850-341-0779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4020 PARK ST N STE 101",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337094030",
            "telephone_number": "727-388-4688",
            "fax_number": "727-388-6887"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "25241 Elementary Way Ste 200",
            "address_purpose": "LOCATION",
            "city": "Bonita Springs",
            "state": "FL",
            "postal_code": "341357883",
            "country_code": "US",
            "telephone_number": "239-947-4184",
            "fax_number": "239-947-4171",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10676 Colonial Blvd Ste 50",
            "address_purpose": "LOCATION",
            "city": "Fort Myers",
            "state": "FL",
            "postal_code": "339138715",
            "country_code": "US",
            "telephone_number": "239-465-4880",
            "fax_number": "239-465-4604",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "GINA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-08-11",
        "last_updated": "2023-03-30",
        "certification_date": "2023-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT36790",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Petersburg, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.