Provider Demographics
NPI:1639475403
Name:GAVRILOS, MARIA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:GAVRILOS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:CONSTANTINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:106 W FAIRMONT AVE
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-2852
Mailing Address - Country:US
Mailing Address - Phone:330-774-7463
Mailing Address - Fax:
Practice Address - Street 1:121 ENCLAVE DR
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-3207
Practice Address - Country:US
Practice Address - Phone:724-202-7908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT022351225100000X
OHPT013503225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1639475403OtherNPI