Individual provider Active NPI

Mary Kay Gavlek, PT

  • Physical Therapist
  • Escanaba, MI
National Provider Identifier
1962904763
Registry record updated Dec 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5501002977 Issued in MI
Practice address
610 S Lincoln Rd
Escanaba, MI 49829-1215
Phone
(906) 786-6488
Fax
(906) 786-6409
NPI assigned
Mar 7, 2018
Last updated
Dec 14, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 5501002977 MI Primary

Addresses

Primary practice location

610 S Lincoln Rd
Escanaba, MI 49829-1215

Mailing address

PO Box 22487
Green Bay, WI 54305-2487
Phone (920) 445-7210

Other practice location 1

440 Woodward Ave
Iron Mountain, MI 49801-4631
Phone (906) 776-9040

Other practice location 2

7870W US Highway 2
Manistique, MI 49854-8992
Phone (906) 341-3254

Other practice location 3

106 S School Rd
Daggett, MI 49821-8555
Phone (906) 753-2155

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, WI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210802001957 MI Practitioner - Physical Therapist in Private Practice 5597169334 Reassigns benefits to 2 organizations
I20230126003511 WI Practitioner - Physical Therapist in Private Practice 5597169334 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Oconto Hospital and Medical Center IncGroup PAC ID 2163461781, shared by 12 NPIs, 217 clinicians
Bellin Memorial Hospital IncGroup PAC ID 8820900749, 685 clinicians

Practice addresses (Care Compare)

106 S School Rd
Daggett, MI 49821-8555
Phone (906) 753-2155

218 S Hwy 141
Crivitz, WI 54114-1677
Phone (715) 854-7477

610 S Lincoln Rd
Bellin Health
Escanaba, MI 49829-1215
Phone (906) 786-6488

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Bellin Memorial Hospital Inc Physical Therapist CurrentSince Jul 7, 2021 Accepting new patients
Oconto Hospital & Medical Center, Inc. CurrentSince Jul 7, 2021 Accepting new patients
Oconto Hospital & Medical Center Inc CurrentSince Jul 7, 2021 Accepting new patients
Oconto Hospital & Medical Center Inc Current Accepting new patients
Oconto Hospital & Medical Center, Inc. Current Accepting new patients
Bellin Memorial Hospital Inc Current Accepting new patients
Oconto Hospital & Medical Center Inc CurrentSince Jan 12, 2023 Accepting new patients
Bellin Memorial Hospital Inc Past Accepting new patients

Locations

106 S School Rd
Daggett, MI 49821
Phone (906) 753-2155

610 S Lincoln Rd
Escanaba, MI 49829
Phone (906) 786-6488

440 Woodward Ave
Iron Mountain, MI 49801
Phone (906) 776-9040

1100 10th St
Menominee, MI 49858
Phone (906) 863-2256

218 S US Highway 141
Crivitz, WI 54114
Phone (715) 854-7477

744 S Webster Ave
Green Bay, WI 54301
Phone (920) 433-6025

744 S Webster Ave
Fl 7
Green Bay, WI 54301

820 Arbutus Ave
Oconto, WI 54153
Phone (920) 835-1100

Organizations & group practices 8

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

NPI Registry JSON

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

{
    "created_epoch": "1520380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670976000000",
    "number": "1962904763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22487",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543052487",
            "telephone_number": "920-445-7210",
            "fax_number": "920-445-7289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 S LINCOLN RD",
            "city": "ESCANABA",
            "state": "MI",
            "postal_code": "498291215",
            "telephone_number": "906-786-6488",
            "fax_number": "906-786-6409"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "440 Woodward Ave",
            "address_purpose": "LOCATION",
            "city": "Iron Mountain",
            "state": "MI",
            "postal_code": "498014631",
            "country_code": "US",
            "telephone_number": "906-776-9040",
            "fax_number": "906-774-5950",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7870W US Highway 2",
            "address_purpose": "LOCATION",
            "city": "Manistique",
            "state": "MI",
            "postal_code": "498548992",
            "country_code": "US",
            "telephone_number": "906-341-3254",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "106 S School Rd",
            "address_purpose": "LOCATION",
            "city": "Daggett",
            "state": "MI",
            "postal_code": "498218555",
            "country_code": "US",
            "telephone_number": "906-753-2155",
            "fax_number": "906-753-2716",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GAVLEK",
        "first_name": "MARY",
        "middle_name": "KAY",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-07",
        "last_updated": "2022-12-14",
        "certification_date": "2022-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501002977",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Escanaba, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.