Provider Demographics
NPI:1124588595
Name:LECAVALIER, KAYLEE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:
Last Name:LECAVALIER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 CROWN COLONY DR STE 102
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-0902
Mailing Address - Country:US
Mailing Address - Phone:781-986-0990
Mailing Address - Fax:781-986-0991
Practice Address - Street 1:2300 CROWN COLONY DR STE 102
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-0902
Practice Address - Country:US
Practice Address - Phone:781-986-0990
Practice Address - Fax:781-986-0991
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA24152225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist