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General NPI Number Information
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NPI Number | 1528752821
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Entity Type | Individual
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Provider Name | JUSTIN TAVORMINA PT, DPT, CSCS
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Gender | Male
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Dates
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Enumeration Date | 06/08/2023
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Last Update Date | 06/08/2023
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Provider Practice Location Address
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Address Line | 2301 W GRAND RIVER AVE
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City | OKEMOS
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State | MI
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Zip | 48864-1648
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Country | US
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Telephone | 517-853-6800
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Fax |
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Provider Business Mailing Address
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Address Line | 7402 WESTSHIRE DR STE 105
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City | LANSING
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State | MI
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Zip | 48917-8687
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501302684
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License Number State | MI
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