Provider Demographics
NPI:1104943414
Name:CAVANAUGH, SANDRA KATHLEEN (PT)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:KATHLEEN
Last Name:CAVANAUGH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:SANDRA
Other - Middle Name:KATHLEEN
Other - Last Name:BECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:114 SUMMER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-6710
Mailing Address - Country:US
Mailing Address - Phone:215-361-7378
Mailing Address - Fax:
Practice Address - Street 1:660 N BROAD ST
Practice Address - Street 2:ELM TERRACE GARDENS
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-2361
Practice Address - Country:US
Practice Address - Phone:215-362-6087
Practice Address - Fax:215-412-3495
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT006901L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist