Clifford Angco Gaviola, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

16695 Issued in MA

Practice address

372 Broadway
Revere, MA 02151-5016

Phone

(781) 485-1001

Fax

(781) 289-6820

NPI assigned

Dec 3, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Boeing Angco Gaviola Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Intercare Group Incorporated

  • Rehabilitation Practitioner
  • Ipswich, MA
  • NPI 1336234830
  NPD (past)
• St. Julie Billiart Residential Care Center

  • Nursing Facility/Intermediate Care Facility
  • Ipswich, MA
  • NPI 1497824544
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1133568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599004800000",
    "number": "1902880883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5730 CORPORATE WAY STE 214",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334072032",
            "telephone_number": "774-218-5585",
            "fax_number": "561-603-6450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "372 BROADWAY",
            "city": "REVERE",
            "state": "MA",
            "postal_code": "021515016",
            "telephone_number": "781-485-1001",
            "fax_number": "781-289-6820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAVIOLA",
        "first_name": "CLIFFORD",
        "middle_name": "ANGCO",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-03",
        "last_updated": "2020-09-02",
        "certification_date": "2020-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MA",
            "license": "16695",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BOEING",
            "last_name": "GAVIOLA",
            "middle_name": "ANGCO",
            "credential": "P.T.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jason Anthony Gambale, D.C.
• Gao Eye Associates LLC
• Zhenzhen Gao, OD
• Philip J Garofalo, P.T.A.
• Claudia Garzon
• Zelalem Gebre
• General Hospital Corp
• Stanley Gerald
• Milton Robert Avery Gholston, MD
• Alicia Giambrone

• Physical Therapist in Revere, MA
• Providers in Revere, MA by specialty
• Physical Therapist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.