Provider Demographics
NPI:1235220377
Name:COUCH, LAVONNE E (PT, EDD, CSCS)
Entity Type:Individual
Prefix:
First Name:LAVONNE
Middle Name:E
Last Name:COUCH
Suffix:
Gender:F
Credentials:PT, EDD, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 964
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-0964
Mailing Address - Country:US
Mailing Address - Phone:609-706-6752
Mailing Address - Fax:856-727-0292
Practice Address - Street 1:300 HARPER DR
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3208
Practice Address - Country:US
Practice Address - Phone:856-552-1300
Practice Address - Fax:856-552-1308
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2012-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015154225100000X
NJ40QA00694000225100000X
DEJ1-0001819225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist