Provider Demographics
NPI:1730203241
Name:CAVIN, JEFFREY DAN (PT, ATC)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DAN
Last Name:CAVIN
Suffix:
Gender:M
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 HICKS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:TROUTMAN
Mailing Address - State:NC
Mailing Address - Zip Code:28166-8670
Mailing Address - Country:US
Mailing Address - Phone:704-995-3684
Mailing Address - Fax:
Practice Address - Street 1:525 HICKS CREEK RD
Practice Address - Street 2:
Practice Address - City:TROUTMAN
Practice Address - State:NC
Practice Address - Zip Code:28166-8670
Practice Address - Country:US
Practice Address - Phone:704-995-3684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9507225100000X
HI2628225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist