Thomas J Cavanaugh, LMT
Individual provider Active NPI Massage Therapist · Dyer, IN
NPI 1770076309 · NPPES record last updated Jun 8, 2018
Key facts
- NPI
- 1770076309
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Massage Therapist 225700000X
- License
- MT21806523 (IN)
- Practice address
- 425 Joliet St Ste 212
Dyer, IN 46311-1766 - Phone
- (219) 381-9772
- NPI assigned
- Jun 8, 2018
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT21806523 | IN | MD | Massage Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | MT21806523 | IN | Yes |
Addresses
Primary practice location
425 Joliet St Ste 212
Dyer, IN 46311-1766
Mailing address
618 214TH St
Dyer, IN 46311-1508
Phone (219) 333-1972
Other providers in Dyer, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 8, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.