Provider Demographics
NPI:1366547721
Name:CAVANAUGH, DEBORAH (PT, MS)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:CAVANAUGH
Suffix:
Gender:F
Credentials:PT, MS
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:KEITH
Other - Last Name:NOEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16 LITTLEJOHN RD
Mailing Address - Street 2:
Mailing Address - City:CAPE ELIZ
Mailing Address - State:ME
Mailing Address - Zip Code:04107-1800
Mailing Address - Country:US
Mailing Address - Phone:207-899-1407
Mailing Address - Fax:
Practice Address - Street 1:1 WESTBROOK CMN STE 2
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-2804
Practice Address - Country:US
Practice Address - Phone:207-854-1239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME3395225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist