Provider Demographics
NPI:1982736708
Name:CAVANAH, ASHLEY PHELPS (PT)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:PHELPS
Last Name:CAVANAH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W WILSON ST
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:KY
Mailing Address - Zip Code:42411-9633
Mailing Address - Country:US
Mailing Address - Phone:270-625-9332
Mailing Address - Fax:
Practice Address - Street 1:PROGRESSIVEHEALTH
Practice Address - Street 2:236 COMMERCE STREET
Practice Address - City:EDDYVILLE
Practice Address - State:KY
Practice Address - Zip Code:42038
Practice Address - Country:US
Practice Address - Phone:270-388-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY004851225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist