Provider Demographics
NPI:1366937799
Name:LAVI, KOREN (PT, DPT)
Entity type:Individual
Prefix:
First Name:KOREN
Middle Name:
Last Name:LAVI
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16522 KEYSTONE BLVD STE N
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-3302
Mailing Address - Country:US
Mailing Address - Phone:303-840-7325
Mailing Address - Fax:
Practice Address - Street 1:16522 KEYSTONE BLVD STE N
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-3302
Practice Address - Country:US
Practice Address - Phone:303-840-7325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0015660225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist