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General NPI Number Information
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NPI Number | 1619733649
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Entity Type | Individual
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Provider Name | BEAU CAVINESS PT
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Gender | Male
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Dates
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Enumeration Date | 02/27/2024
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Last Update Date | 04/03/2024
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Provider Practice Location Address
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Address Line | 550 FIELDSTOWN RD
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City | GARDENDALE
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State | AL
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Zip | 35071-2590
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Country | US
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Telephone | 205-418-1482
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Fax | 205-608-5179
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Provider Business Mailing Address
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Address Line | 790 REMINGTON BLVD
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City | BOLINGBROOK
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State | IL
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Zip | 60440-4909
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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 | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number | PTH11733
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License Number State | AL
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Taxonomy #2
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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 | AL
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