Provider Demographics
NPI:1700220423
Name:GAVIN, THERESA MARIE (PT)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:MARIE
Last Name:GAVIN
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 1:666 SALEM RD
Mailing Address - Street 2:
Mailing Address - City:ETTERS
Mailing Address - State:PA
Mailing Address - Zip Code:17319-9541
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 TRINITY DR E STE 110
Practice Address - Street 2:
Practice Address - City:DILLSBURG
Practice Address - State:PA
Practice Address - Zip Code:17019-8522
Practice Address - Country:US
Practice Address - Phone:717-432-7719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE1003277225200000X
NY007017225200000X
PAPT032517225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant