Healthcare Provider Details

I. General information

NPI: 1891868683
Provider Name (Legal Business Name): RENEE GAVRISH MIDGETT PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RENEE GAVRISH

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 05/28/2020
Certification Date: 05/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 BATTLEFIELD BLVD N STE 200
CHESAPEAKE VA
23320-4853
US

IV. Provider business mailing address

350 NEW FIDELITY CT
GARNER NC
27529-2665
US

V. Phone/Fax

Practice location:
  • Phone: 757-436-3350
  • Fax: 757-547-9367
Mailing address:
  • Phone: 919-258-2714
  • Fax: 410-648-4878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305002839
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: