Individual
THOMAS GAVIN GRAVINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
37 WOODLANDS DR, WAYMART, PA 18472-9366
(570) 687-5540
Mailing address
37 WOODLANDS DR, WAYMART, PA 18472-9366
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
005676
PA
Other
Enumeration date
03/03/2022
Last updated
03/03/2022
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