Provider Demographics
NPI:1275521007
Name:LAVALLEY, KATHRYN E (PT MS)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:E
Last Name:LAVALLEY
Suffix:
Gender:F
Credentials:PT MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BOOTH DR
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-6404
Mailing Address - Country:US
Mailing Address - Phone:518-561-2225
Mailing Address - Fax:518-561-2212
Practice Address - Street 1:12 BOOTH DR
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-6404
Practice Address - Country:US
Practice Address - Phone:518-561-2225
Practice Address - Fax:518-561-2212
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0235781225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RA5168Medicare ID - Type Unspecified
P46167Medicare UPIN