Provider Demographics
NPI:1508851767
Name:GAVITO, CAROLYN L (PT)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:L
Last Name:GAVITO
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 1:1144 ARGENTO DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-4911
Mailing Address - Country:US
Mailing Address - Phone:970-493-8775
Mailing Address - Fax:
Practice Address - Street 1:4025 AUTOMATION WAY
Practice Address - Street 2:B-1
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3446
Practice Address - Country:US
Practice Address - Phone:970-472-1072
Practice Address - Fax:970-472-1071
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2335225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO802188Medicare UPIN