Provider Demographics
NPI:1679573224
Name:DICROCCO, GINA MARIA (ATC)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:MARIA
Last Name:DICROCCO
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 HIGH STREET
Mailing Address - Street 2:
Mailing Address - City:STRONG
Mailing Address - State:ME
Mailing Address - Zip Code:04983
Mailing Address - Country:US
Mailing Address - Phone:207-491-1056
Mailing Address - Fax:207-779-2585
Practice Address - Street 1:111 FRANKLIN HEALTH CMNS
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938-6144
Practice Address - Country:US
Practice Address - Phone:207-779-2621
Practice Address - Fax:207-779-2585
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAT842255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer