Provider Demographics
NPI:1275051013
Name:LAVIOLETTE, MICHAEL JAMES II (DPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAMES
Last Name:LAVIOLETTE
Suffix:II
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 INTERNATIONAL CIR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119-1130
Mailing Address - Country:US
Mailing Address - Phone:408-972-3517
Mailing Address - Fax:
Practice Address - Street 1:70 POST OFFICE PARK STE 7007
Practice Address - Street 2:
Practice Address - City:WILBRAHAM
Practice Address - State:MA
Practice Address - Zip Code:01095-1291
Practice Address - Country:US
Practice Address - Phone:413-273-1435
Practice Address - Fax:413-279-1438
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT2935802251X0800X
MA23670225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic