| Doctor Name: | DONNA TAVALIERI |
| NPI Number: | 1043484165 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | P.T. |
| License Number: | 5501003814 |
| Business Practice Address: | 19505 E 8 Mile Rd Saint Clair Shores, MI - 480801643 |
| Business Phone Number: | 5864458200 |
| Business Fax Number: | 5864458201 |
| Mailing Address: | 23256 Robert John St, SAINT CLAIR SHORES |
| State: | MI |
| Postal Code: | 480802609 |
| Phone Number: | 5864458200 |
| Fax Number: | 5864458201 |
| NPI Enumeration Date: | 04/18/2008 |
| NPI Last Update Date: | 11/09/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251P0200X |
| License Number: | 5501003814 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |