Provider Demographics
NPI:1528508082
Name:LAVIMODIERE, COURTNEY (DPT)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:
Last Name:LAVIMODIERE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MARLA PL
Mailing Address - Street 2:
Mailing Address - City:FEEDING HILLS
Mailing Address - State:MA
Mailing Address - Zip Code:01030-2633
Mailing Address - Country:US
Mailing Address - Phone:914-584-2608
Mailing Address - Fax:
Practice Address - Street 1:110 CHERRY ST
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-7002
Practice Address - Country:US
Practice Address - Phone:914-584-2608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-03
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20126225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist