Provider Demographics
NPI:1891868683
Name:MIDGETT, RENEE GAVRISH (PT, DPT)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:GAVRISH
Last Name:MIDGETT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:GAVRISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:350 NEW FIDELITY CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2665
Mailing Address - Country:US
Mailing Address - Phone:919-258-2714
Mailing Address - Fax:410-648-4878
Practice Address - Street 1:927 BATTLEFIELD BLVD N STE 200
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4853
Practice Address - Country:US
Practice Address - Phone:757-436-3350
Practice Address - Fax:757-547-9367
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305002839225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1891868683Medicaid
VAC05954Medicare PIN
VA1891868683Medicaid