Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1043514680 |
---|---|
Provider Name | Marc Lavigne |
First Address | Las Vegas, NV 89128-0811 |
Second Address | Las Vegas, NV 89128-0811 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2010 |
Last Update Date | 07/01/2011 |