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NPI Code Detail

MEDICARE: SUSAN ELIZABETH GAVIN PTA

MEDICARE: SUSAN ELIZABETH GAVIN PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant3233MA

General Provider Information

NPI Number : 1245354646
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN ELIZABETH GAVIN PTA
Provider Business Mailing Address
First Line : 233 AQUIDNECK ST
Second Line :
City : NEW BEDFORD
State : MA
Zip : 02744-1401
Country : US
Telephone Number : 508-994-5109
Fax Number :
Provider Business Practice Location Address
First Line : 495 NEW BOSTON RD
Second Line :
City : FALL RIVER
State : MA
Zip : 02720-5835
Country : US
Telephone Number : 508-679-0109
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/19/2007
Last Update Date : 07/08/2007

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