Provider Demographics
NPI:1205377397
Name:LAVALLEE, RORY CONNOR (PT, DPT, ATC)
Entity Type:Individual
Prefix:
First Name:RORY
Middle Name:CONNOR
Last Name:LAVALLEE
Suffix:
Gender:F
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9768 LIBERTY DR
Mailing Address - Street 2:
Mailing Address - City:PAINTED POST
Mailing Address - State:NY
Mailing Address - Zip Code:14870-9094
Mailing Address - Country:US
Mailing Address - Phone:607-937-4800
Mailing Address - Fax:607-937-4888
Practice Address - Street 1:9768 LIBERTY DR
Practice Address - Street 2:
Practice Address - City:PAINTED POST
Practice Address - State:NY
Practice Address - Zip Code:14870-9094
Practice Address - Country:US
Practice Address - Phone:607-937-4800
Practice Address - Fax:607-937-4888
Is Sole Proprietor?:No
Enumeration Date:2017-03-09
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22725225100000X
MA28942255A2300X
NH06282255A2300X
NY0028132255A2300X
NY042284225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer