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General NPI Number Information
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NPI Number | 1639475403
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Entity Type | Individual
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Provider Name | MARIA GAVRILOS PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 01/26/2011
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Last Update Date | 10/23/2018
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Provider Practice Location Address
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Address Line | 121 ENCLAVE DR
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City | NEW CASTLE
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State | PA
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Zip | 16105-3207
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Country | US
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Telephone | 724-202-7908
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Fax |
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Provider Business Mailing Address
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Address Line | 106 W FAIRMONT AVE
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City | NEW CASTLE
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State | PA
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Zip | 16105-2852
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Country | US
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Telephone | 330-774-7463
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT022351
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT013503
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License Number State | OH
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