Provider Demographics
NPI:1275626160
Name:LEXINGTON PHYSICAL THERAPY ASSOCIATES INC
Entity Type:Organization
Organization Name:LEXINGTON PHYSICAL THERAPY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVIOLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:781-861-8884
Mailing Address - Street 1:35 BEDFORD ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-4320
Mailing Address - Country:US
Mailing Address - Phone:781-861-8884
Mailing Address - Fax:781-861-7665
Practice Address - Street 1:35 BEDFORD ST
Practice Address - Street 2:SUITE 5
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4320
Practice Address - Country:US
Practice Address - Phone:781-861-8884
Practice Address - Fax:781-861-7665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA800168OtherTUFTS HEALTH PLAN
MAY65629OtherBCBS OF MASSACHUSETTS
MAPT0022Medicare ID - Type Unspecified