Provider Demographics
NPI:1215417712
Name:CAVALLARO, KATHERINE ROSE (DPT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ROSE
Last Name:CAVALLARO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CONTINENTAL BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:MERRIMACK
Mailing Address - State:NH
Mailing Address - Zip Code:03054-4341
Mailing Address - Country:US
Mailing Address - Phone:603-424-1950
Mailing Address - Fax:603-424-4749
Practice Address - Street 1:11 CONTINENTAL BLVD STE A
Practice Address - Street 2:
Practice Address - City:MERRIMACK
Practice Address - State:NH
Practice Address - Zip Code:03054-4341
Practice Address - Country:US
Practice Address - Phone:603-424-1950
Practice Address - Fax:603-424-4749
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23765225100000X
NH4625225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist