Provider Demographics
NPI:1184949604
Name:LAVINE, ERIN M (DPT)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:M
Last Name:LAVINE
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:PO BOX 586
Mailing Address - Street 2:
Mailing Address - City:SPEONK
Mailing Address - State:NY
Mailing Address - Zip Code:11972-0586
Mailing Address - Country:US
Mailing Address - Phone:631-325-3400
Mailing Address - Fax:631-325-3407
Practice Address - Street 1:295 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:SPEONK
Practice Address - State:NY
Practice Address - Zip Code:11972-0586
Practice Address - Country:US
Practice Address - Phone:631-325-3400
Practice Address - Fax:631-325-3407
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031916225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist