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General NPI Number Information
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NPI Number | 1619538071
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Entity Type | Individual
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Provider Name | CARLI T KAVANAGH DPT
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Gender | Female
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Dates
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Enumeration Date | 06/26/2019
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Last Update Date | 06/26/2019
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Provider Practice Location Address
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Address Line | 1600 16TH ST STE T14
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City | OAK BROOK
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State | IL
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Zip | 60523-8795
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Country | US
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Telephone | 630-572-9700
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Fax | 630-572-0706
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Provider Business Mailing Address
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Address Line | 600 OAKMONT LN STE 600C
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City | WESTMONT
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State | IL
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Zip | 60559-5548
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Country | US
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Telephone | 630-575-1980
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Fax | 630-928-5080
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State | IL
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