Provider Demographics
NPI:1720420144
Name:CAVERNO, STEVEN MATHEW (PTA)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:MATHEW
Last Name:CAVERNO
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 CLIPPER DR
Mailing Address - Street 2:
Mailing Address - City:WOLFEBORO
Mailing Address - State:NH
Mailing Address - Zip Code:03894-4222
Mailing Address - Country:US
Mailing Address - Phone:603-569-3950
Mailing Address - Fax:
Practice Address - Street 1:39 CLIPPER DR
Practice Address - Street 2:
Practice Address - City:WOLFEBORO
Practice Address - State:NH
Practice Address - Zip Code:03894-4222
Practice Address - Country:US
Practice Address - Phone:603-569-3950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1117225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant