IndividualActive
Michelle Tavera, DPT
NPI 1639027675 · Pediatric Physical Therapist · Superior, WI
Provider details
- NPI number
- 1639027675
- Entity type
- Individual
- Primary specialty
- Pediatric Physical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service Providers
- Credential
- DPT
- Sole proprietor
- No
- License
- 4260-24 (WI)
Specialties & taxonomies
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Practice location
1423 Central Ave
Superior, WI 54880-5963
Phone: (715) 394-8785
Approximate (ZIP-level) locationGet directions
Mailing address
1423 Central Ave
Superior, WI 54880-5963
Registry dates
- Enumerated
- 2026-03-17
- Last updated
- 2026-03-17
- Certified
- 2026-03-17
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.