MEDICARE: ABIGAIL CAVALLO

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	2251G0304X	Geriatric Physical Therapist	047329	NY

General Provider Information

NPI Number	:	1508411836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIGAIL CAVALLO

Provider Business Mailing Address
First Line	:	32 LAWRENCE AVE
Second Line	:	STE 110
City	:	SMITHTOWN
State	:	NY
Zip	:	11787-3605
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	32 LAWRENCE AVE
Second Line	:	STE 110
City	:	SMITHTOWN
State	:	NY
Zip	:	11787-3605
Country	:	US
Telephone Number	:	412-673-5005
Fax Number	:

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

Provider Enumeration Date	:	08/05/2019
Last Update Date	:	10/26/2021

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Directions to “ ABIGAIL CAVALLO ” Practice Location

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