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General NPI Number Information
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NPI Number | 1700220423
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Entity Type | Individual
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Provider Name | THERESA MARIE GAVIN PT
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Gender | Female
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Dates
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Enumeration Date | 04/24/2013
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Last Update Date | 08/07/2024
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Provider Practice Location Address
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Address Line | 1 TRINITY DR E STE 110
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City | DILLSBURG
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State | PA
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Zip | 17019-8522
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Country | US
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Telephone | 717-432-7719
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Fax |
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Provider Business Mailing Address
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Address Line | 666 SALEM RD
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City | ETTERS
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State | PA
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Zip | 17319-9541
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Country | US
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Telephone |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | TE1003277
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 007017
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT032517
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License Number State | PA
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