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General NPI Number Information
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NPI Number | 1902123110
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Entity Type | Individual
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Provider Name | PENNY CAVIN PTA
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Gender | Female
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Dates
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Enumeration Date | 04/27/2010
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Last Update Date | 04/27/2010
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Provider Practice Location Address
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Address Line | 1010 S 336TH ST STE 210
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City | FEDERAL WAY
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State | WA
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Zip | 98003-6385
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Country | US
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Telephone | 253-835-8091
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Fax | 253-835-7102
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Provider Business Mailing Address
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Address Line | 29835 45TH AVE S
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City | AUBURN
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State | WA
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Zip | 98001-2910
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Country | US
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Telephone | 206-429-3262
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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 | 60033376
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License Number State | WA
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