Individual
TANNER CACCAVALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, LAT, ATC
Contact information
Practice address
210 MOUNTS CORNER DR, FREEHOLD, NJ 07728-2547
(732) 724-2433
Mailing address
122 ATLANTIC AVE, MANASQUAN, NJ 08736-2929
(732) 962-3483
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
25MT00319600
NJ
Other
Enumeration date
08/29/2023
Last updated
08/29/2023
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