Basic Information
| Provider Information | |||||||||
| NPI: | 1063021061 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HISKY | ||||||||
| FirstName: | GINA | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10820 OLD COURT RD | ||||||||
| Address2: | |||||||||
| City: | WOODSTOCK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211631107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108524086 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2240 GREENSPRING DR | ||||||||
| Address2: | |||||||||
| City: | TIMONIUM | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210933114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109893833 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2020 | ||||||||
| LastUpdateDate: | 07/08/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 27973 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.