Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA 18111 | FL |
NPI | 1013063692 |
---|---|
Provider Name | Kevin Mccavera |
First Address | Dunnellon, FL 34431-2985 |
Second Address | Crystal River, FL 34429-4891 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2007 |
Last Update Date | 08/07/2007 |