Provider Demographics
NPI:1730625252
Name:CAVE, QUENTIN ROOSEVELT (LAT, ATC)
Entity type:Individual
Prefix:
First Name:QUENTIN
Middle Name:ROOSEVELT
Last Name:CAVE
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1423 S STRONG AVE
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-1919
Mailing Address - Country:US
Mailing Address - Phone:574-596-4958
Mailing Address - Fax:
Practice Address - Street 1:67530 US HIGHWAY 33
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-8552
Practice Address - Country:US
Practice Address - Phone:574-831-2184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-07
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN36003170A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program