Provider Demographics
NPI:1003069360
Name:CAVAZOS, ELIZABETH SHIRLEY (PT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SHIRLEY
Last Name:CAVAZOS
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:PO BOX 2200
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-0722
Mailing Address - Country:US
Mailing Address - Phone:909-793-9737
Mailing Address - Fax:909-798-8749
Practice Address - Street 1:245 TERRACINA BLVD
Practice Address - Street 2:202
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4852
Practice Address - Country:US
Practice Address - Phone:909-792-9737
Practice Address - Fax:909-798-8749
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34972225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist