# MR. GLENN EDWARD LAVALLEE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1821242819
- **Gender:** Man
- **Credential:** MSPT

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2251P0200X | Pediatric Physical Therapist | 026269-1 | NY | Yes |

## Other

- **Enumeration date:** 11/05/2008
- **Last updated:** 05/28/2010