Provider Demographics
NPI:1114976768
Name:GARRISON, GARY WAYNE (RPT)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:WAYNE
Last Name:GARRISON
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 LAMOILLE HWY
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-4321
Mailing Address - Country:US
Mailing Address - Phone:775-738-0818
Mailing Address - Fax:775-738-0814
Practice Address - Street 1:1501 LAMOILLE HWY
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-4321
Practice Address - Country:US
Practice Address - Phone:775-738-0818
Practice Address - Fax:775-738-0814
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0592225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVR27608Medicare UPIN
NVV33019Medicare PIN