Provider Demographics
NPI:1477359602
Name:LAVERTU, KEVIN (PT, DPT)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:LAVERTU
Suffix:
Gender:
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 CYPRESS ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-3538
Mailing Address - Country:US
Mailing Address - Phone:909-305-1383
Mailing Address - Fax:
Practice Address - Street 1:1335 CYPRESS ST STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-3538
Practice Address - Country:US
Practice Address - Phone:909-305-1383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA307644225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist