Provider Demographics
NPI:1962619973
Name:GAVRILIS, KRISTINE MARIE (PT)
Entity type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:MARIE
Last Name:GAVRILIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4620 SILVER SPRING RD
Mailing Address - Street 2:
Mailing Address - City:PERRY HALL
Mailing Address - State:MD
Mailing Address - Zip Code:21128-9008
Mailing Address - Country:US
Mailing Address - Phone:973-222-2711
Mailing Address - Fax:
Practice Address - Street 1:2001 N WARWICK AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-3203
Practice Address - Country:US
Practice Address - Phone:410-396-0833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22139225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist