Healthcare Provider Details

I. General information

NPI: 1538895743
Provider Name (Legal Business Name): CARMEN ANN MAY PAVLIK PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2022
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 E VERONA AVE
VERONA WI
53593-1227
US

IV. Provider business mailing address

PO BOX 720908
NORMAN OK
73070-4708
US

V. Phone/Fax

Practice location:
  • Phone: 608-848-6628
  • Fax: 608-828-6629
Mailing address:
  • Phone: 405-809-8713
  • Fax: 405-573-6768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number16022-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: