Provider Demographics
NPI:1083928444
Name:LAVACCA, JOSEPH D (DPT)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:D
Last Name:LAVACCA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:584 BROADWAY
Mailing Address - Street 2:SUITE 710
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-5242
Mailing Address - Country:US
Mailing Address - Phone:212-941-0503
Mailing Address - Fax:212-941-6195
Practice Address - Street 1:584 BROADWAY
Practice Address - Street 2:SUITE 710
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-5242
Practice Address - Country:US
Practice Address - Phone:212-941-0503
Practice Address - Fax:212-941-6195
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY032843-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist