Provider Demographics
NPI:1164141545
Name:CAVE PHYSICAL THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:CAVE PHYSICAL THERAPY SERVICES, LLC
Other - Org Name:MYPHYSIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:CAVE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:817-213-6087
Mailing Address - Street 1:6852 SEACOAST DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-6827
Mailing Address - Country:US
Mailing Address - Phone:325-207-4704
Mailing Address - Fax:
Practice Address - Street 1:500 S WISTERIA ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063
Practice Address - Country:US
Practice Address - Phone:325-207-4704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-26
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty