MEDICARE: DAVID WILLIAM KAVANAGH PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT18524	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1144315391	OTHER	FL	FACILITY NPI NUMBER
2	GG9	OTHER	FL	BCBS FACILITY PROVIDER NO

General Provider Information

NPI Number	:	1093918542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID WILLIAM KAVANAGH PT

Provider Business Mailing Address
First Line	:	6321 54TH AVE N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33709-1703
Country	:	US
Telephone Number	:	727-545-9902
Fax Number	:	727-457-0264

Provider Business Practice Location Address
First Line	:	6321 54TH AVE N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33709-1703
Country	:	US
Telephone Number	:	727-545-9902
Fax Number	:	727-457-0264

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2007
Last Update Date	:	07/09/2007

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Directions to “ DAVID WILLIAM KAVANAGH PT” Practice Location

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