Healthcare Provider Details

I. General information

NPI: 1811952344
Provider Name (Legal Business Name): NICOLE MARIE CAVINESS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE MARIE LYNCH-BUSH PT

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 06/23/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3826 HWY 49 SOUTH
HARRISBURG NC
28075-7439
US

IV. Provider business mailing address

11417 THREE SISTERS LN
MINT HILL NC
28227-3639
US

V. Phone/Fax

Practice location:
  • Phone: 704-787-1807
  • Fax: 704-626-3066
Mailing address:
  • Phone: 704-787-1807
  • Fax: 866-570-1759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP8413
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: