Provider Demographics
NPI:1689656332
Name:HOUCK, GINGER (PT)
Entity type:Individual
Prefix:
First Name:GINGER
Middle Name:
Last Name:HOUCK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:GINGER
Other - Middle Name:
Other - Last Name:BYRD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:9530 COSNER DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-7760
Mailing Address - Country:US
Mailing Address - Phone:540-361-1830
Mailing Address - Fax:540-361-1829
Practice Address - Street 1:2800 WELLFORD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3176
Practice Address - Country:US
Practice Address - Phone:540-361-1830
Practice Address - Fax:540-361-1829
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305002828225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4330530001OtherDMERC
VA019321O12Medicare PIN
S36901Medicare UPIN