Healthcare Provider Details

I. General information

NPI: 1487453023
Provider Name (Legal Business Name): CAREY CAVENDER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2025
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 MOUNTAIN PLACE DR
MOUNTAIN VIEW AR
72560-6802
US

IV. Provider business mailing address

PO BOX 2398
MOUNTAIN HOME AR
72654-2398
US

V. Phone/Fax

Practice location:
  • Phone: 870-269-5215
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA4815
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: