Caitlin Cavanaugh, DPT
Individual provider Active NPI Physical Therapist · Cass Lake, MN
NPI 1124411582 · NPPES record last updated Aug 16, 2022
Key facts
- NPI
- 1124411582
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- P15492 (NC)
- Practice address
- 425 7TH St NW
Cass Lake, MN 56633-3360 - Phone
- (218) 335-3200
- Fax
- (218) 335-3327
- NPI assigned
- Mar 10, 2015
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NC, TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150707002167 | NC | Practitioner - Physical Therapist in Private Practice | 5890007710 | Reassigns benefits to 1 organization |
| I20161227000710 | TX | Practitioner - Physical Therapist in Private Practice | 5890007710 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P15492 | NC | MD | Physical Therapist |
| 15492 | NC | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Department of Health & Human Services PHS IHS | Current |
Accepting new patients | |
| Activcare Physical Therapy, LLC | Physical Therapist | Current |
Accepting new patients |
Locations
350 E Devon Ave
Itasca, IL 60143
425 7th St NW
Cass Lake, MN 56633
Phone (218) 335-3200
1613 Walnut St
Cary, NC 27511
Phone (919) 290-2799
166 Springbrook Ave
Ste 201
Clayton, NC 27520
Phone (919) 535-8461
1340 Walter Reed Rd
Ste 102
Fayetteville, NC 28304
Phone (910) 568-4614
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | P15492 | NC | Yes |
Addresses
Primary practice location
425 7TH St NW
Cass Lake, MN 56633-3360
Mailing address
2309 Birchmont Dr NE
Bemidji, MN 56601-2325
Phone (218) 335-3200
Other providers in Cass Lake, MN
- Aaron Carter
- Terri Lynn Carter
- Cass Lake Indian Hospital
- Cass Lake Indian Hospital Pharmacy
- Cass Lake-Bena Isd #115
- Stacy Ann Cederstrom
- Linda Conner
- Joseph Cook Jr.
- Adrian A. Cordovi
- Lauren Bernice Crunden
All providers in Cass Lake, MN · Physical Therapist in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 16, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.