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NPI Code Detail

MEDICARE: MICHAEL S CAVAZOS PT, DPT, OCS

MEDICARE: MICHAEL S CAVAZOS PT, DPT, OCS
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
1225100000XPhysical Therapist41945CA
2225100000XPhysical Therapist26916MD

General Provider Information

NPI Number : 1114324233
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL S CAVAZOS PT, DPT, OCS
Provider Business Mailing Address
First Line : 20410 CENTURY BLVD STE 215
Second Line :
City : GERMANTOWN
State : MD
Zip : 20874-1187
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 18109 PRINCE PHILIP DR STE 155
Second Line :
City : OLNEY
State : MD
Zip : 20832-1591
Country : US
Telephone Number : 855-546-2066
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2014
Last Update Date : 04/17/2018

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