Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT 25768 | FL |
NPI | 1003113358 |
---|---|
Provider Name | Dr. David Alan Lavin |
First Address | Rome, GA 30162-0949 |
Second Address | Fernandina Beach, FL 32034-1948 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2011 |
Last Update Date | 17/03/2011 |