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Individual

JESSIE W. CAVAZOS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DPT, OCS

Contact information

Practice address
655 MOLLY LN, SUITE 100, WOODSTOCK, GA 30189-6503
(770) 517-1080
Mailing address
546 LOST CREEK DR, WOODSTOCK, GA 30188-1631

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
031754
NY
225100000X
Physical Therapist
24212
FL
225100000X
Physical Therapist
Primary
PT011804
GA

Other

Enumeration date
09/16/2008
Last updated
11/28/2017
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