Provider Demographics
NPI:1922839943
Name:WILLENS, GAVIN CLAY (PT, DPT, CSCS)
Entity type:Individual
Prefix:DR
First Name:GAVIN
Middle Name:CLAY
Last Name:WILLENS
Suffix:
Gender:M
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 CEDAR RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MILLERS CREEK
Mailing Address - State:NC
Mailing Address - Zip Code:28651-9042
Mailing Address - Country:US
Mailing Address - Phone:336-452-7056
Mailing Address - Fax:
Practice Address - Street 1:200 W PARK CIR STE A
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3583
Practice Address - Country:US
Practice Address - Phone:336-818-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP23425225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist