=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831455385
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAITLIN LEIGH MCGARVEY PT, DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2012
-----------------------------------------------------
Last Update Date | 11/24/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26 CONKEY AVE
-----------------------------------------------------
City | NORWICH
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13815-1756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-337-4227
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26 CONKEY AVE
-----------------------------------------------------
City | NORWICH
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13815-1756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT021409
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 036871
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------