Healthcare Provider Details

I. General information

NPI: 1154265742
Provider Name (Legal Business Name): ALTIVITAS HOLISTIC WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1049 MAIN ST
WEST BARNSTABLE MA
02668-1152
US

IV. Provider business mailing address

1049 MAIN ST
WEST BARNSTABLE MA
02668-1152
US

V. Phone/Fax

Practice location:
  • Phone: 508-250-0568
  • Fax: 866-711-4542
Mailing address:
  • Phone: 508-250-0568
  • Fax: 866-711-4542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LINDSAY LACORTE
Title or Position: MEDICAL DIRECTOR
Credential: DO
Phone: 508-250-0568