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General NPI Number Information
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NPI Number | 1902870744
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Entity Type | Individual
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Provider Name | MARTIN A GAVIN PT, D.P.M
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Gender | Male
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Dates
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Enumeration Date | 02/16/2006
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Last Update Date | 08/03/2010
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Provider Practice Location Address
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Address Line | 17 BROOKDALE AVE
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City | MILFORD
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State | CT
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Zip | 06460-5934
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Country | US
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Telephone | 203-336-7312
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Fax |
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Provider Business Mailing Address
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Address Line | 226 MILL HILL AVE
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City | BRIDGEPORT
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State | CT
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Zip | 06610-0120
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Country | US
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Telephone | 203-336-7312
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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 | PT002233
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | P00368
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License Number State | CT
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