Provider Demographics
NPI:1689066334
Name:CAVANAGH, KRISTIN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:CAVANAGH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:MCGORTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:376 DUER RD
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:NY
Mailing Address - Zip Code:12834-7328
Mailing Address - Country:US
Mailing Address - Phone:845-242-2316
Mailing Address - Fax:
Practice Address - Street 1:133 AVIATION RD
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-8206
Practice Address - Country:US
Practice Address - Phone:518-798-0170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-04
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038121225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist