Provider Demographics
NPI:1588865315
Name:CAVOTTA, MICHELLE NICOLE (PTA)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:NICOLE
Last Name:CAVOTTA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:NICOLE
Other - Last Name:LEBED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:22 PARKSIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:SPOTSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08884
Mailing Address - Country:US
Mailing Address - Phone:732-416-1383
Mailing Address - Fax:
Practice Address - Street 1:61 MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:CRANBURY
Practice Address - State:NJ
Practice Address - Zip Code:08512
Practice Address - Country:US
Practice Address - Phone:609-395-3445
Practice Address - Fax:609-655-2052
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00199500225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant