Provider Demographics
NPI:1225597867
Name:GOVENDER, GARETH ROGERS (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:GARETH
Middle Name:ROGERS
Last Name:GOVENDER
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8324 INVERNESS
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-6466
Mailing Address - Country:US
Mailing Address - Phone:310-625-1794
Mailing Address - Fax:
Practice Address - Street 1:2601 W RANDOL MILL RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-4289
Practice Address - Country:US
Practice Address - Phone:817-274-5571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1314952225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist