Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 11540 | CO |
N | 2251X0800X | Physical Therapist - Orthopedic | 31108 | AZ |
N | 2251X0800X | Physical Therapist - Orthopedic | 8656 | AZ |
NPI | 1023332186 |
---|---|
Provider Name | Mr. Michael Paul Dovico |
First Address | Phoenix, AZ 85060-0217 |
Second Address | Chandler, AZ 85226-1513 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2010 |
Last Update Date | 19/02/2021 |