Individual
GINA MARIE DEBERNARDO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
713 PINE FOREST TRL E, PORT ORANGE, FL 32127-4872
(386) 405-0588
Mailing address
713 PINE FOREST TRL E, PORT ORANGE, FL 32127-4872
(386) 405-0588
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA30379
FL
Other
Enumeration date
08/06/2007
Last updated
01/22/2009
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