Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 23082 | NY |
NPI | 1104061308 |
---|---|
Provider Name | Mrs. Kellee Bruce Lavalley |
First Address | Plattsburgh, NY 12985 |
Second Address | Plattsburgh, NY 12985 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2008 |
Last Update Date | 03/12/2008 |