Provider Demographics
NPI:1255700332
Name:GARGANO, CARMINE J (PT)
Entity type:Individual
Prefix:
First Name:CARMINE
Middle Name:J
Last Name:GARGANO
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 1:2360 FREEDOM BLVD APT C8
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-6183
Mailing Address - Country:US
Mailing Address - Phone:908-210-1680
Mailing Address - Fax:
Practice Address - Street 1:2360 FREEDOM BLVD APT C8
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505
Practice Address - Country:US
Practice Address - Phone:908-210-1680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-18
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA082089225100000X
NJ40QA01620200225100000X
SC8869225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist