Provider Demographics
NPI:1972757250
Name:CAVALLARO, LAURA (DPT, MS, PCS)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:CAVALLARO
Suffix:
Gender:F
Credentials:DPT, MS, PCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 VANDERBILT AVE
Mailing Address - Street 2:
Mailing Address - City:ISLAND PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11558-1998
Mailing Address - Country:US
Mailing Address - Phone:917-747-4030
Mailing Address - Fax:
Practice Address - Street 1:17105 137TH AVE
Practice Address - Street 2:PS 80
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-4521
Practice Address - Country:US
Practice Address - Phone:718-528-7874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0177142251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics