Provider Demographics
NPI:1700062643
Name:LAVIGNE, VALERIE JEANNE BUCKLEY (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:JEANNE BUCKLEY
Last Name:LAVIGNE
Suffix:
Gender:F
Credentials:MSPT
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 2842
Mailing Address - Street 2:
Mailing Address - City:EDGARTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02539-2842
Mailing Address - Country:US
Mailing Address - Phone:781-632-6551
Mailing Address - Fax:
Practice Address - Street 1:83 PEARL ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3922
Practice Address - Country:US
Practice Address - Phone:508-775-6240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17207225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist