Provider Demographics
NPI:1710013149
Name:GAVINO-POOCK, MILDRED G (PT)
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:G
Last Name:GAVINO-POOCK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 SOLDIERS FIELD DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-4085
Mailing Address - Country:US
Mailing Address - Phone:281-565-8614
Mailing Address - Fax:281-325-1077
Practice Address - Street 1:1401 SOLDIERS FIELD DR
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-4085
Practice Address - Country:US
Practice Address - Phone:281-565-8614
Practice Address - Fax:281-325-1077
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX676559Medicare Oscar/Certification
TX676564Medicare Oscar/Certification
TX00936XMedicare ID - Type UnspecifiedPART B GROUP NUMBER
TX676554Medicare Oscar/Certification
TX676555Medicare Oscar/Certification
TX676626Medicare Oscar/Certification
TX676600Medicare Oscar/Certification