Provider Demographics
NPI:1194255380
Name:MCGIVERN, JINNY (PT, DPT, CFMT)
Entity type:Individual
Prefix:
First Name:JINNY
Middle Name:
Last Name:MCGIVERN
Suffix:
Gender:F
Credentials:PT, DPT, CFMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3536 28TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-3202
Mailing Address - Country:US
Mailing Address - Phone:914-420-1710
Mailing Address - Fax:
Practice Address - Street 1:3536 28TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-3202
Practice Address - Country:US
Practice Address - Phone:914-420-1710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038149225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist