MEDICARE: MRS. MICHELLE MARIE KAVOURAS PT

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
1	225100000X	Physical Therapist	PT 18820	FL

General Provider Information

NPI Number	:	1760449086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELLE MARIE KAVOURAS PT

Provider Business Mailing Address
First Line	:	PO BOX 242037
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36124-2037
Country	:	US
Telephone Number	:	334-396-3273
Fax Number	:	334-396-4905

Provider Business Practice Location Address
First Line	:	16201 PANAMA CITY BEACH PKWY
Second Line	:	SUITE A
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32413-5301
Country	:	US
Telephone Number	:	850-250-0826
Fax Number	:	850-250-0840

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	09/24/2015

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