Provider Demographics
NPI:1013259803
Name:LAVIGNE, WENDY MICHELLE (DPT)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:MICHELLE
Last Name:LAVIGNE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 S 4TH ST
Mailing Address - Street 2:APT 305
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-5210
Mailing Address - Country:US
Mailing Address - Phone:662-231-7060
Mailing Address - Fax:
Practice Address - Street 1:4816 RIVERDALE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38141-8529
Practice Address - Country:US
Practice Address - Phone:901-522-6830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000081472251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic