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General NPI Number Information
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NPI Number | 1619847977
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Entity Type | Individual
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Provider Name | PAVEL PAVLOV DPT
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Gender | Male
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Dates
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Enumeration Date | 11/10/2025
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Last Update Date | 11/10/2025
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Provider Practice Location Address
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Address Line | 345 S HALCYON RD
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City | ARROYO GRANDE
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State | CA
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Zip | 93420-3817
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Country | US
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Telephone | 180-548-9426
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Fax |
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Provider Business Mailing Address
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Address Line | 127 CENTER RD
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City | GRAND BLANC
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State | MI
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Zip | 48439-1028
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Country | US
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Telephone | 323-423-0363
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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 | 308374
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License Number State | CA
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