Provider Demographics
NPI:1811066681
Name:GDOVIN, ROBERT M (PT)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:M
Last Name:GDOVIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 S MANOA RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-3301
Mailing Address - Country:US
Mailing Address - Phone:610-853-3570
Mailing Address - Fax:
Practice Address - Street 1:1 BALA PLZ
Practice Address - Street 2:SUITE 134
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1403
Practice Address - Country:US
Practice Address - Phone:610-668-4055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT-005514-L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA575479OtherHIGHMARK BLUE SHIELD
PA2081214000OtherINDEPENDENCE BLUE CROSS
PA575479OtherHIGHMARK BLUE SHIELD