Provider Demographics
NPI:1417150558
Name:MYERS, MICHELLE CACCAVO (MPT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:CACCAVO
Last Name:MYERS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:DEBRA
Other - Last Name:CACCAVO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:130 RIVER LANDING DR
Mailing Address - Street 2:#4111
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29492-7400
Mailing Address - Country:US
Mailing Address - Phone:352-246-4371
Mailing Address - Fax:
Practice Address - Street 1:905 DUKES ST
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:SC
Practice Address - Zip Code:29477-2059
Practice Address - Country:US
Practice Address - Phone:843-563-4602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC52582251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics