Provider Demographics
NPI:1124630272
Name:LAVERY, VICTORIA ROSE (PT)
Entity type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:ROSE
Last Name:LAVERY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3347 W 12TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-3725
Mailing Address - Country:US
Mailing Address - Phone:814-838-1223
Mailing Address - Fax:814-838-1223
Practice Address - Street 1:3347 W 12TH ST STE 101
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-3725
Practice Address - Country:US
Practice Address - Phone:814-838-1223
Practice Address - Fax:814-838-1223
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT027709208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation