Provider Demographics
NPI:1194741033
Name:LAVIGNE, BRIAN J (PT)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:J
Last Name:LAVIGNE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 RIVERSIDE ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-1304
Mailing Address - Country:US
Mailing Address - Phone:603-886-1690
Mailing Address - Fax:603-886-9803
Practice Address - Street 1:17 RIVERSIDE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-1304
Practice Address - Country:US
Practice Address - Phone:603-886-1690
Practice Address - Fax:603-886-9803
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2147225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE5901Medicare ID - Type Unspecified