Provider Demographics
NPI:1093060196
Name:GAVIGAN, JOHN T (DPT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:GAVIGAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 PARK PLACE DR
Mailing Address - Street 2:
Mailing Address - City:SINKING SPRING
Mailing Address - State:PA
Mailing Address - Zip Code:19608-9779
Mailing Address - Country:US
Mailing Address - Phone:484-955-6543
Mailing Address - Fax:
Practice Address - Street 1:103 FLORAL VALE BLVD
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-5522
Practice Address - Country:US
Practice Address - Phone:215-860-4270
Practice Address - Fax:215-860-2270
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT-022165225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist