Provider Demographics
NPI:1225029911
Name:LAVINSKY, AVRAM (PT)
Entity Type:Individual
Prefix:
First Name:AVRAM
Middle Name:
Last Name:LAVINSKY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1807
Mailing Address - Country:US
Mailing Address - Phone:978-452-6121
Mailing Address - Fax:978-452-8991
Practice Address - Street 1:103 MARKET ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1807
Practice Address - Country:US
Practice Address - Phone:978-452-6121
Practice Address - Fax:978-452-8991
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11574225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY68261OtherBCBS
MAY68261OtherBCBS