Individual
DONNA TAVALIERI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
19505 E 8 MILE RD, SAINT CLAIR SHORES, MI 48080-1643
(586) 445-8200
(586) 445-8201
Mailing address
23256 ROBERT JOHN ST, SAINT CLAIR SHORES, MI 48080-2609
(586) 445-8200
(586) 445-8201
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
5501003814
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5501003814
STATE LICENSE NUMBER
MI
Enumeration date
04/18/2008
Last updated
11/09/2010
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