Provider Demographics
NPI:1659500288
Name:LAVIGNE, ANTHONY FREDERICK (DPT)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:FREDERICK
Last Name:LAVIGNE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3424 SHELBY RAY CT
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5838
Mailing Address - Country:US
Mailing Address - Phone:843-402-7765
Mailing Address - Fax:843-766-2943
Practice Address - Street 1:1818 HENDERSON ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2619
Practice Address - Country:US
Practice Address - Phone:803-782-4278
Practice Address - Fax:803-253-8896
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-02
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5977225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist