Provider Demographics
NPI:1689465783
Name:GAVIOLI, MARISSA FRANCES (PT)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:FRANCES
Last Name:GAVIOLI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:FRANCES
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2072 MICHAEL LN
Mailing Address - Street 2:
Mailing Address - City:RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54022-4598
Mailing Address - Country:US
Mailing Address - Phone:262-745-8149
Mailing Address - Fax:
Practice Address - Street 1:225 OSTERMANN DR
Practice Address - Street 2:
Practice Address - City:TURTLE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54889-9011
Practice Address - Country:US
Practice Address - Phone:715-986-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1717924225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist