Provider Demographics
NPI:1164659850
Name:LOVALLO, DEBORAH M (LMT)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:M
Last Name:LOVALLO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 VERNON PL
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-2013
Mailing Address - Country:US
Mailing Address - Phone:716-864-3678
Mailing Address - Fax:
Practice Address - Street 1:295 MAIN ST
Practice Address - Street 2:ELLICOTT SQUARE BUILDING - SUITE 740
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-2412
Practice Address - Country:US
Practice Address - Phone:716-854-4555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-19
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018430-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist