Provider Demographics
NPI:1386939965
Name:GAVIN, MELISSA M (MSPT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:M
Last Name:GAVIN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
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Mailing Address - Street 1:24569 ROUTE 6
Mailing Address - Street 2:SUITE C
Mailing Address - City:TOWANDA
Mailing Address - State:PA
Mailing Address - Zip Code:18848-8254
Mailing Address - Country:US
Mailing Address - Phone:570-265-1111
Mailing Address - Fax:570-265-7134
Practice Address - Street 1:1564 ROUTE 507
Practice Address - Street 2:SUITE C
Practice Address - City:GREENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18426-4502
Practice Address - Country:US
Practice Address - Phone:570-676-0700
Practice Address - Fax:570-676-0766
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
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Provider Licenses
StateLicense IDTaxonomies
PA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist