Healthcare Provider Details

I. General information

NPI: 1710526462
Provider Name (Legal Business Name): STEVEN CAVINS ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2019
Last Update Date: 12/29/2019
Certification Date: 12/29/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35765 NORTHLINE RD
ROMULUS MI
48174-3647
US

IV. Provider business mailing address

4151 SWAN RIDGE LN
NEWPORT MI
48166-6603
US

V. Phone/Fax

Practice location:
  • Phone: 734-941-2126
  • Fax: 734-941-2283
Mailing address:
  • Phone: 419-350-0278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: