Provider Demographics
NPI:1639307770
Name:CAVALLO, NICOLA ROSARIO (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:NICOLA
Middle Name:ROSARIO
Last Name:CAVALLO
Suffix:
Gender:M
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 1:18083 CLEAR BROOK CIR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498-1941
Mailing Address - Country:US
Mailing Address - Phone:844-978-2466
Mailing Address - Fax:561-922-1312
Practice Address - Street 1:18083 CLEAR BROOK CIR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33498-1941
Practice Address - Country:US
Practice Address - Phone:844-978-2466
Practice Address - Fax:561-922-1312
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-28
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT32285225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist