Individual
ELLEN GAVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
26507
MD
225100000X
Physical Therapist
Primary
PT004264
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26507
MARYLAND BOARD OF PHYSICAL THERAPY
MD
Enumeration date
06/14/2017
Last updated
04/07/2022
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