Provider Demographics
NPI:1417672783
Name:PAVEY, CAROLINE LEIGH (DPT)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:LEIGH
Last Name:PAVEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:LEIGH
Other - Last Name:GROENDYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2100 RAYBROOK ST SE STE 303
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-5783
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2100 RAYBROOK ST SE STE 303
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-5783
Practice Address - Country:US
Practice Address - Phone:616-235-4663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501302085225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist