Basic Information
Provider Information
NPI: 1922254739
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CAVALERA
FirstName: ARIKA
MiddleName: N
NamePrefix:  
NameSuffix:  
Credential: PTA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2222 SULLIVAN TRL
Address2:  
City: EASTON
State: PA
PostalCode: 180407958
CountryCode: US
TelephoneNumber: 8009449782
FaxNumber: 6104382024
Practice Location
Address1: 1401 WONDER WORLD DR
Address2:  
City: SAN MARCOS
State: TX
PostalCode: 786667555
CountryCode: US
TelephoneNumber: 5127548230
FaxNumber: 5127548230
Other Information
ProviderEnumerationDate: 08/12/2008
LastUpdateDate: 08/12/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225200000X2065420TXY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant 

No ID Information.


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