Basic Information
| Provider Information | |||||||||
| NPI: | 1952736159 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GAVURA | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | |||||||||
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| NameSuffix: | |||||||||
| Credential: | PT | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5924 | ||||||||
| Address2: | 7208 E. CAVE CREEK RD | ||||||||
| City: | CAREFREE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853775924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804889095 | ||||||||
| FaxNumber: | 4804882862 | ||||||||
| Practice Location | |||||||||
| Address1: | 7208 E. CAVE CREEK RD | ||||||||
| Address2: | |||||||||
| City: | CAREFREE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853375924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804889095 | ||||||||
| FaxNumber: | 4804882862 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2013 | ||||||||
| LastUpdateDate: | 09/06/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 6249 | AZ | Y | Other Service Providers | Specialist |
No ID Information.