Provider Demographics
NPI:1003113358
Name:LAVIN, DAVID ALAN (PT,DPT,CSCS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALAN
Last Name:LAVIN
Suffix:
Gender:M
Credentials:PT,DPT,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 949
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30162-0949
Mailing Address - Country:US
Mailing Address - Phone:706-236-2774
Mailing Address - Fax:706-802-1408
Practice Address - Street 1:1897 ISLAND WALK WAY
Practice Address - Street 2:UNIT 6
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-1948
Practice Address - Country:US
Practice Address - Phone:904-261-4664
Practice Address - Fax:904-261-5852
Is Sole Proprietor?:No
Enumeration Date:2011-02-23
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 25768225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist