Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 0000008147 | TN |
NPI | 1013259803 |
---|---|
Provider Name | Dr. Wendy Michelle Lavigne |
First Address | Memphis, TN 38103-5210 |
Second Address | Memphis, TN 38141-8529 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2013 |
Last Update Date | 20/03/2013 |