Provider Demographics
NPI:1427770619
Name:MARVIN, GAYLENE (CMT)
Entity type:Individual
Prefix:
First Name:GAYLENE
Middle Name:
Last Name:MARVIN
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26982 TWIN PONDS RD
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-9653
Mailing Address - Country:US
Mailing Address - Phone:707-978-8220
Mailing Address - Fax:
Practice Address - Street 1:26982 TWIN PONDS RD
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93619-9653
Practice Address - Country:US
Practice Address - Phone:707-978-8220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38358225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist