Provider Demographics
NPI:1811011786
Name:GAUVIN, JASON JAMES (PT, SCS, ATC, CSCS)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:JAMES
Last Name:GAUVIN
Suffix:
Gender:M
Credentials:PT, SCS, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 CREEK PARK DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-5650
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6224 FAYETTEVILLE RD
Practice Address - Street 2:STE. 101
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713
Practice Address - Country:US
Practice Address - Phone:919-484-0033
Practice Address - Fax:919-484-3008
Is Sole Proprietor?:No
Enumeration Date:2007-03-18
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC60732251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports