MEDICARE: ANGELA LAVELLE PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT016419	PA

General Provider Information

NPI Number	:	1639568413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA LAVELLE PT

Provider Business Mailing Address
First Line	:	5 HILLTOP RD
Second Line	:
City	:	HUGHESTOWN
State	:	PA
Zip	:	18640-2936
Country	:	US
Telephone Number	:	570-654-1319
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 HILLTOP RD
Second Line	:
City	:	HUGHESTOWN
State	:	PA
Zip	:	18640-2936
Country	:	US
Telephone Number	:	570-654-1319
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2015
Last Update Date	:	01/15/2015

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Directions to “ ANGELA LAVELLE PT” Practice Location

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