Basic Information
| Provider Information | |||||||||
| NPI: | 1861897860 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAVALLEE | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | ROBERT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7310 S ALTON WAY | ||||||||
| Address2: | #6L | ||||||||
| City: | CENTENNIAL | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801122334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037904495 | ||||||||
| FaxNumber: | 7204881988 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 CASTLETON RD | ||||||||
| Address2: | #100 | ||||||||
| City: | CASTLE ROCK | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801097552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036883914 | ||||||||
| FaxNumber: | 3036884499 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2014 | ||||||||
| LastUpdateDate: | 12/12/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | 1214402 | TX | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | 2251X0800X | 11-04959 | KS | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | 225100000X | 0013040 | CO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.