Provider Demographics
NPI:1972886547
Name:CAVANAUGH, TONI MARIE (PT,)
Entity type:Individual
Prefix:MISS
First Name:TONI
Middle Name:MARIE
Last Name:CAVANAUGH
Suffix:
Gender:F
Credentials:PT,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 PLEASANT ST
Mailing Address - Street 2:KNO WAL LIN
Mailing Address - City:ROCKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04841-2119
Mailing Address - Country:US
Mailing Address - Phone:207-594-9561
Mailing Address - Fax:
Practice Address - Street 1:170 PLEASANT ST
Practice Address - Street 2:KNO WAL LIN
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841-2119
Practice Address - Country:US
Practice Address - Phone:207-594-9561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT1142225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist