Provider Demographics
NPI:1801077086
Name:TAVARES, DANA MICHAEL (LMT,CPT)
Entity type:Individual
Prefix:MR
First Name:DANA
Middle Name:MICHAEL
Last Name:TAVARES
Suffix:
Gender:M
Credentials:LMT,CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 EGYPT RD
Mailing Address - Street 2:
Mailing Address - City:DAMARISCOTTA
Mailing Address - State:ME
Mailing Address - Zip Code:04543-4322
Mailing Address - Country:US
Mailing Address - Phone:207-563-2737
Mailing Address - Fax:207-563-2737
Practice Address - Street 1:400 EGYPT RD
Practice Address - Street 2:
Practice Address - City:DAMARISCOTTA
Practice Address - State:ME
Practice Address - Zip Code:04543-4322
Practice Address - Country:US
Practice Address - Phone:207-563-2737
Practice Address - Fax:207-563-2737
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT1780172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist