Provider Demographics
NPI:1679542906
Name:JAVENS, DENNIS C (PT, SCS, ATC)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:C
Last Name:JAVENS
Suffix:
Gender:M
Credentials:PT, SCS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 CAMPUS CIR
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-7901
Mailing Address - Country:US
Mailing Address - Phone:724-346-1529
Mailing Address - Fax:724-346-1498
Practice Address - Street 1:1005 CAMPUS CIR
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-7901
Practice Address - Country:US
Practice Address - Phone:724-346-1529
Practice Address - Fax:724-346-1498
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPTO10812L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1009529020001Medicaid
PA1009529020001Medicaid
PAQ18587Medicare UPIN