Individual
BRANDI L CAVNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MPT
Contact information
Practice address
1009 W QUINN RD, POCATELLO, ID 83202-2425
(208) 238-0088
(208) 238-0055
Mailing address
5820 TURF DR, POCATELLO, ID 83204-4664
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-1078
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000-10144181
BLUE SHIELD
ID
01
—
5479460
CCN
ID
01
—
5744703
FIRST HEALTH
ID
01
—
610872200
DOL-ACS OWCP
ID
01
—
7042522
AETNA
ID
01
—
731656010
TRICARE
ID
05
—
806629100
—
ID
01
—
85120066610450
REGENCE LIFE & HEALTH
ID
01
—
TD401
BLUE CROSS OF IDAHO
ID
Enumeration date
04/02/2007
Last updated
11/28/2023
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