Provider Demographics
NPI:1487750923
Name:LAVENDA, ALAN R (MSPT)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:R
Last Name:LAVENDA
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:200 PROVIDENCE HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026
Mailing Address - Country:US
Mailing Address - Phone:781-326-8332
Mailing Address - Fax:781-326-8262
Practice Address - Street 1:200 PROVIDENCE HIGHWAY
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026
Practice Address - Country:US
Practice Address - Phone:781-326-8332
Practice Address - Fax:781-326-8262
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17230225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA494299OtherTUFTS
817690OtherAETNA
MAY68462OtherBLUE CROSS BLUE SHIELD
6400217OtherUNITED HEALTHCARE
613720OtherHARVARD PILGRIM HLTH CARE
P00289050OtherRR MEDICARE
6400217OtherUNITED HEALTHCARE