Provider Demographics
NPI:1548474851
Name:ATHLETIC ADVANTAGE, INC.
Entity type:Organization
Organization Name:ATHLETIC ADVANTAGE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO, PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:GAUVIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, ATC, SCS, CSCS
Authorized Official - Phone:919-484-0033
Mailing Address - Street 1:203 CREEK PARK DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-5650
Mailing Address - Country:US
Mailing Address - Phone:919-484-0033
Mailing Address - Fax:919-484-3008
Practice Address - Street 1:6224 FAYETTEVILLE RD
Practice Address - Street 2:STE. 101
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713
Practice Address - Country:US
Practice Address - Phone:919-484-0033
Practice Address - Fax:919-484-3008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC60732251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty