Provider Demographics
NPI:1386704500
Name:LAVELLE, HEATHER MACAULAY (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:MACAULAY
Last Name:LAVELLE
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:MRS
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:LAVELLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:205 SOUTHWIND DR NE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-1085
Mailing Address - Country:US
Mailing Address - Phone:330-372-9209
Mailing Address - Fax:
Practice Address - Street 1:205 SOUTHWIND DR NE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-1085
Practice Address - Country:US
Practice Address - Phone:330-603-5324
Practice Address - Fax:330-856-9005
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7040225100000X
PA057250225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist