Provider Demographics
NPI:1467172544
Name:HERR, GAVIN (CMT)
Entity Type:Individual
Prefix:
First Name:GAVIN
Middle Name:
Last Name:HERR
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 SANTA ANA RD
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-7109
Mailing Address - Country:US
Mailing Address - Phone:831-334-1659
Mailing Address - Fax:
Practice Address - Street 1:421 SANTA ANA RD
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-7109
Practice Address - Country:US
Practice Address - Phone:831-222-0606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74334225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist