Provider Demographics
NPI:1679808901
Name:GONZALEZ ECHAVARRI, JAVIER (PT)
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:
Last Name:GONZALEZ ECHAVARRI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 RUNNYMEDE AVE
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2020
Mailing Address - Country:US
Mailing Address - Phone:215-885-1297
Mailing Address - Fax:
Practice Address - Street 1:217 RUNNYMEDE AVE
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-2020
Practice Address - Country:US
Practice Address - Phone:215-885-1297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017525225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist