Provider Demographics
NPI:1952736159
Name:GAVURA, MICHELLE (PT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:GAVURA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5924
Mailing Address - Street 2:7208 E. CAVE CREEK RD
Mailing Address - City:CAREFREE
Mailing Address - State:AZ
Mailing Address - Zip Code:85377-5924
Mailing Address - Country:US
Mailing Address - Phone:480-488-9095
Mailing Address - Fax:480-488-2862
Practice Address - Street 1:7208 E. CAVE CREEK RD
Practice Address - Street 2:
Practice Address - City:CAREFREE
Practice Address - State:AZ
Practice Address - Zip Code:85337-5924
Practice Address - Country:US
Practice Address - Phone:480-488-9095
Practice Address - Fax:480-488-2862
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6249174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist