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Individual

DOUGLAS PATRICK BEVILACQUA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
39901 TRADITIONS DR, NORTHVILLE, MI 48168-9493
(248) 305-4400
(248) 305-4401
Mailing address
36053 ALLEN ST, LIVONIA, MI 48154-5212

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
5502000232
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
5502000232
MI
05
5502000232
MI
Enumeration date
03/06/2018
Last updated
07/21/2022
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