Provider Demographics
NPI:1538169362
Name:LAVALLEE, SCOTT R (PT)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:R
Last Name:LAVALLEE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 COMMONS AVE
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-5554
Mailing Address - Country:US
Mailing Address - Phone:207-892-7642
Mailing Address - Fax:207-892-8440
Practice Address - Street 1:4 COMMONS AVE
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-5554
Practice Address - Country:US
Practice Address - Phone:207-892-7642
Practice Address - Fax:207-892-8440
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT1552225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME040668OtherBC/BS OF MAINE
ME040668OtherBC/BS OF MAINE