Provider Demographics
NPI:1811952344
Name:CAVINESS, NICOLE MARIE (PT)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:MARIE
Last Name:CAVINESS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:NICOLE
Other - Middle Name:MARIE
Other - Last Name:LYNCH-BUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:12897 HILL PINE RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28107-7815
Mailing Address - Country:US
Mailing Address - Phone:704-787-1807
Mailing Address - Fax:704-626-3066
Practice Address - Street 1:3826 HWY 49 SOUTH
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-7439
Practice Address - Country:US
Practice Address - Phone:704-787-1807
Practice Address - Fax:704-626-3066
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8413225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC17308OtherPARTNES MEDICARE
3443137OtherAETNA HMO
7556543OtherAETNA PPO
NC0173UOtherBC
3443137OtherAETNA HMO