Healthcare Provider Details

I. General information

NPI: 1952736159
Provider Name (Legal Business Name): MICHELLE GAVURA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2013
Last Update Date: 09/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7208 E. CAVE CREEK RD
CAREFREE AZ
85337-5924
US

IV. Provider business mailing address

PO BOX 5924 7208 E. CAVE CREEK RD
CAREFREE AZ
85377-5924
US

V. Phone/Fax

Practice location:
  • Phone: 480-488-9095
  • Fax: 480-488-2862
Mailing address:
  • Phone: 480-488-9095
  • Fax: 480-488-2862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number6249
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: