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NPI Code Detail

MEDICARE: ABBEY PAVLOSKY PTA

MEDICARE: ABBEY PAVLOSKY PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208100000XPhysical Medicine & Rehabilitation Physician5502006293MI

General Provider Information

NPI Number : 1821867755
Entity Type Code : Individual
Provider Name (Legal Business Name) : ABBEY PAVLOSKY PTA
Provider Business Mailing Address
First Line : 20952 E 12 MILE RD STE 110
Second Line :
City : SAINT CLAIR SHORES
State : MI
Zip : 48081-3202
Country : US
Telephone Number : 586-498-3500
Fax Number : 586-498-3510
Provider Business Practice Location Address
First Line : 20952 E 12 MILE RD STE 110
Second Line :
City : SAINT CLAIR SHORES
State : MI
Zip : 48081-3202
Country : US
Telephone Number : 586-498-3500
Fax Number : 586-498-3510
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2023
Last Update Date : 12/20/2023

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Directions to “ ABBEY PAVLOSKY PTA” Practice Location

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