Provider Demographics
NPI:1629756754
Name:LAVIGNE, ALICIA ANNE (BS)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:ANNE
Last Name:LAVIGNE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2868 DAMASCUS RD
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:KY
Mailing Address - Zip Code:41048-9745
Mailing Address - Country:US
Mailing Address - Phone:859-640-1434
Mailing Address - Fax:
Practice Address - Street 1:2868 DAMASCUS RD
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:KY
Practice Address - Zip Code:41048-9745
Practice Address - Country:US
Practice Address - Phone:859-640-1434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program