Individual
MRS. BRENDA KAVANAGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3400 W WASHINGTON ST, SPRINGFIELD, IL 62711-7917
(217) 787-9600
Mailing address
161 CIRCLE DR, SPRINGFIELD, IL 62703-4806
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160000874
IL
Other
Enumeration date
08/12/2008
Last updated
08/12/2008
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