Provider Demographics
NPI:1194400523
Name:LAVELLE, MARIE JEAN (DPT, PT)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:JEAN
Last Name:LAVELLE
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 SCOTT DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37777-5004
Mailing Address - Country:US
Mailing Address - Phone:570-614-8206
Mailing Address - Fax:
Practice Address - Street 1:7811 OAK RIDGE HWY STE 3
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37931-2345
Practice Address - Country:US
Practice Address - Phone:865-313-2445
Practice Address - Fax:865-313-2455
Is Sole Proprietor?:No
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15027225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist