Individual
MR. JOSEPH MICHAEL PAVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Contact information
Practice address
2499 W COTA DR, BLOOMINGTON, IN 47403-4217
(812) 353-9319
Mailing address
1301 W COUNTRYSIDE LN, BLOOMINGTON, IN 47403-3260
(219) 608-4171
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36001860A
IN
2255A2300X
Athletic Trainer
AT002238
GA
Other
Enumeration date
11/22/2011
Last updated
03/17/2018
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