Provider Demographics
NPI:1417086927
Name:CAVALLO, DONNA MARIA (PT, DPT)
Entity Type:Individual
Prefix:MISS
First Name:DONNA
Middle Name:MARIA
Last Name:CAVALLO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 BENNETT ST
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-2524
Mailing Address - Country:US
Mailing Address - Phone:631-786-9541
Mailing Address - Fax:
Practice Address - Street 1:277 INDIAN HEAD RD
Practice Address - Street 2:
Practice Address - City:KINGS PARK
Practice Address - State:NY
Practice Address - Zip Code:11754-4803
Practice Address - Country:US
Practice Address - Phone:631-269-5170
Practice Address - Fax:631-269-5283
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020796-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist