Provider Demographics
NPI:1639214380
Name:ALVES, MICHAEL L (ATC, CSCS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:L
Last Name:ALVES
Suffix:
Gender:M
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:12 VICTORIA ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02125-1813
Mailing Address - Country:US
Mailing Address - Phone:413-218-6607
Mailing Address - Fax:617-287-0921
Practice Address - Street 1:1359 WASHINGTON ST
Practice Address - Street 2:BOSTON SPORTS CLUBS
Practice Address - City:WEST NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02465-2004
Practice Address - Country:US
Practice Address - Phone:617-332-1700
Practice Address - Fax:617-332-1719
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA12332255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer