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General NPI Number Information
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NPI Number | 1013063692
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Entity Type | Individual
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Provider Name | KEVIN MCCAVERA
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Gender | Male
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 255 SE 7TH AVE
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City | CRYSTAL RIVER
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State | FL
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Zip | 34429-4891
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Country | US
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Telephone | 352-795-4114
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Fax |
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Provider Business Mailing Address
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Address Line | 21500 SW MONACO CT
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City | DUNNELLON
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State | FL
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Zip | 34431-2985
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA 18111
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License Number State | FL
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