Provider Demographics
NPI:1487712105
Name:HOUGH, GENA (PT)
Entity type:Individual
Prefix:
First Name:GENA
Middle Name:
Last Name:HOUGH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1838
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33802-1838
Mailing Address - Country:US
Mailing Address - Phone:863-687-0931
Mailing Address - Fax:863-687-4021
Practice Address - Street 1:1301 GRASSLANDS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-5401
Practice Address - Country:US
Practice Address - Phone:863-413-0713
Practice Address - Fax:863-682-0058
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT2333225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY0865ZMedicare UPIN