Provider Demographics
NPI:1578035887
Name:CAVANAUGH, JOHN TERENCE (PT MED ATC SCS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:TERENCE
Last Name:CAVANAUGH
Suffix:
Gender:M
Credentials:PT MED ATC SCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 BURNS AVE
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-1132
Mailing Address - Country:US
Mailing Address - Phone:917-375-2897
Mailing Address - Fax:
Practice Address - Street 1:535 E 70TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4898
Practice Address - Country:US
Practice Address - Phone:212-606-1005
Practice Address - Fax:212-774-2089
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-27
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy