Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT423 | ME |
NPI | 1003004631 |
---|---|
Provider Name | Terry Thomas Cavanaugh |
First Address | Sitka, AK 99835-9416 |
Second Address | Sitka, AK 99835-9416 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2007 |
Last Update Date | 30/06/2009 |