Provider Demographics
NPI:1124154364
Name:KAVANAUGH, GEORGEANNA KATHERINE (LMT)
Entity type:Individual
Prefix:MS
First Name:GEORGEANNA
Middle Name:KATHERINE
Last Name:KAVANAUGH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 W SPEEDWAY BLVD # 6
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-9647
Mailing Address - Country:US
Mailing Address - Phone:520-241-7024
Mailing Address - Fax:
Practice Address - Street 1:1643 E PRINCE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-1936
Practice Address - Country:US
Practice Address - Phone:520-319-9711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-01095P225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist