Provider Demographics
NPI:1366709305
Name:GYSELINCK MCMAHON, ANNE MARIE (PTA)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:GYSELINCK MCMAHON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:MARIE
Other - Last Name:GYSELINCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:5301 40TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-5609
Mailing Address - Country:US
Mailing Address - Phone:727-366-7066
Mailing Address - Fax:
Practice Address - Street 1:5301 40TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-5609
Practice Address - Country:US
Practice Address - Phone:727-366-7066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 118225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant