MEDICARE: CAREY CAVENDER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	PTA4815	AR

General Provider Information

NPI Number	:	1487453023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAREY CAVENDER

Provider Business Mailing Address
First Line	:	PO BOX 2398
Second Line	:
City	:	MOUNTAIN HOME
State	:	AR
Zip	:	72654-2398
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 MOUNTAIN PLACE DR
Second Line	:
City	:	MOUNTAIN VIEW
State	:	AR
Zip	:	72560-6802
Country	:	US
Telephone Number	:	870-269-5215
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2025
Last Update Date	:	03/07/2025

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Directions to “ CAREY CAVENDER ” Practice Location

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