Provider Demographics
NPI:1619467313
Name:NATU-EL, AVA MICHELLE
Entity Type:Individual
Prefix:
First Name:AVA
Middle Name:MICHELLE
Last Name:NATU-EL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24140 KONARSKA DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN
Mailing Address - State:MI
Mailing Address - Zip Code:48134-6035
Mailing Address - Country:US
Mailing Address - Phone:734-846-1005
Mailing Address - Fax:
Practice Address - Street 1:481 VILLAGE GREEN LN
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-3367
Practice Address - Country:US
Practice Address - Phone:734-242-6282
Practice Address - Fax:734-242-6491
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013856225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist