Provider Demographics
NPI:1679609986
Name:CAVENDER, ASHLEY DAWN (PT)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:DAWN
Last Name:CAVENDER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1413 SAINT GREGORY LN
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63304-6726
Mailing Address - Country:US
Mailing Address - Phone:314-941-6417
Mailing Address - Fax:
Practice Address - Street 1:1413 SAINT GREGORY LN
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63304-6726
Practice Address - Country:US
Practice Address - Phone:314-941-6417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO487496903Medicaid