Provider Demographics
NPI:1154352102
Name:GDOVIN, BRIGITTE
Entity type:Individual
Prefix:MRS
First Name:BRIGITTE
Middle Name:
Last Name:GDOVIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRIGITTE
Other - Middle Name:
Other - Last Name:PURUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:945 HAVERFORD RD
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3814
Mailing Address - Country:US
Mailing Address - Phone:610-525-1223
Mailing Address - Fax:610-525-5797
Practice Address - Street 1:945 HAVERFORD RD
Practice Address - Street 2:1ST FLOOR
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3814
Practice Address - Country:US
Practice Address - Phone:610-525-1223
Practice Address - Fax:610-525-5797
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT005574L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist