Provider Demographics
NPI:1104061308
Name:LAVALLEY, KELLEE BRUCE (MPT)
Entity type:Individual
Prefix:MRS
First Name:KELLEE
Middle Name:BRUCE
Last Name:LAVALLEY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 MARGARET ST.
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12985
Mailing Address - Country:US
Mailing Address - Phone:518-561-6361
Mailing Address - Fax:518-561-6367
Practice Address - Street 1:185 MARGARET STREET
Practice Address - Street 2:SUITE 1000
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12985
Practice Address - Country:US
Practice Address - Phone:518-561-6361
Practice Address - Fax:518-561-6367
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230822251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics