1275051013 NPI number — MICHAEL JAMES LAVIOLETTE II DPT

Table of content: CASSALYN MARIE HOSP RN (NPI 1962175182)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275051013 NPI number — MICHAEL JAMES LAVIOLETTE II DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAVIOLETTE
Provider First Name:
MICHAEL
Provider Middle Name:
JAMES
Provider Name Prefix Text:
Provider Name Suffix Text:
II
Provider Credential Text:
DPT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275051013
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
270 INTERNATIONAL CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95119-1130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-972-3517
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
70 POST OFFICE PARK STE 7007
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILBRAHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01095-1291
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-273-1435
Provider Business Practice Location Address Fax Number:
413-279-1438
Provider Enumeration Date:
08/31/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X , with the licence number:  PT293580 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 23670 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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