Individual
BEVERLY LAVIGNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
16023 S 31ST WAY, PHOENIX, AZ 85048-7725
(480) 478-8777
Mailing address
16023 S 31ST WAY, PHOENIX, AZ 85048-7725
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA10691A
AZ
Other
Enumeration date
11/13/2014
Last updated
11/13/2014
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