Provider Demographics
NPI:1841022530
Name:HARRELL, GAVIN CHRISTOPHER JAMES (PT, DPT)
Entity type:Individual
Prefix:
First Name:GAVIN
Middle Name:CHRISTOPHER JAMES
Last Name:HARRELL
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19404 HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-9527
Mailing Address - Country:US
Mailing Address - Phone:530-737-7148
Mailing Address - Fax:
Practice Address - Street 1:85 HARTNELL AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1887
Practice Address - Country:US
Practice Address - Phone:530-226-9242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA306667225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA306667OtherPHYSICAL THERAPY BOARD OF CALIFORNIA