Provider Demographics
NPI:1407277619
Name:ONGSINGCO, GAVIN (PT, DPT, OCS)
Entity Type:Individual
Prefix:
First Name:GAVIN
Middle Name:
Last Name:ONGSINGCO
Suffix:
Gender:M
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-4047
Mailing Address - Country:US
Mailing Address - Phone:818-326-4817
Mailing Address - Fax:
Practice Address - Street 1:2117 S BIRCH ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-5017
Practice Address - Country:US
Practice Address - Phone:818-326-4817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-16
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40816225100000X
COPTL.00159062251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA112215Medicare PIN
CACA179522Medicare PIN