Provider Demographics
NPI:1366818007
Name:CAVLAN, EILEEN M (CMT, PTA)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:M
Last Name:CAVLAN
Suffix:
Gender:F
Credentials:CMT, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:873 REDBIRD DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-2824
Mailing Address - Country:US
Mailing Address - Phone:408-829-7579
Mailing Address - Fax:
Practice Address - Street 1:1021 BLOSSOM HILL RD STE 20
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-1188
Practice Address - Country:US
Practice Address - Phone:408-375-8918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-17
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATCH 21377183700000X
CAAT 8167225200000X
CACAMTC 53390225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No183700000XPharmacy Service ProvidersPharmacy Technician
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant