Provider Demographics
NPI:1912414418
Name:PAVLICH, CLAIRE CAMILLE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:CAMILLE
Last Name:PAVLICH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 14TH ST NE APT 535
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-7688
Mailing Address - Country:US
Mailing Address - Phone:440-338-7456
Mailing Address - Fax:
Practice Address - Street 1:6475 JIMMY CARTER BLVD STE 200
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-1734
Practice Address - Country:US
Practice Address - Phone:717-972-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-05
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251X0800X
AZ13561225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic