Individual
MICHELLE TAVERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Credential
DPT
Contact information
Practice address
1423 CENTRAL AVE, SUPERIOR, WI 54880-5963
(715) 394-8785
Mailing address
1423 CENTRAL AVE, SUPERIOR, WI 54880-5963
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
4260-24
WI
Other
Enumeration date
03/17/2026
Last updated
03/17/2026
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