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General NPI Number Information
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NPI Number | 1689066334
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Entity Type | Individual
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Provider Name | KRISTIN CAVANAGH PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 03/04/2015
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Last Update Date | 06/20/2019
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Provider Practice Location Address
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Address Line | 133 AVIATION RD
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City | QUEENSBURY
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State | NY
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Zip | 12804-8206
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Country | US
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Telephone | 518-798-0170
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Fax |
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Provider Business Mailing Address
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Address Line | 376 DUER RD
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City | GREENWICH
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State | NY
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Zip | 12834-7328
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Country | US
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Telephone | 845-242-2316
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 038121
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License Number State | NY
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