Healthcare Provider Details

I. General information

NPI: 1720010564
Provider Name (Legal Business Name): GAVIN MATTHEWS P.T
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 BELLE CHASSE HWY SUITE 208
TERRYTOWN LA
70056-7156
US

IV. Provider business mailing address

4633 WICHERS DR
MARRERO LA
70072-3064
US

V. Phone/Fax

Practice location:
  • Phone: 504-433-8744
  • Fax: 504-433-8740
Mailing address:
  • Phone: 504-347-5421
  • Fax: 504-378-9331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number03245PT
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: