MEDICARE: MR. PATRICK DENNIS LAVALLIE

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	235Z00000X	Speech-Language Pathologist	SA1438	FL

General Provider Information

NPI Number	:	1568927481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PATRICK DENNIS LAVALLIE

Provider Business Mailing Address
First Line	:	208 TRAFALGAR WAY
Second Line	:
City	:	LAKE PLACID
State	:	FL
Zip	:	33852-7906
Country	:	US
Telephone Number	:	954-675-8842
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 US 27 N
Second Line	:
City	:	AVON PARK
State	:	FL
Zip	:	33825-2556
Country	:	US
Telephone Number	:	863-453-5200
Fax Number	:

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

Provider Enumeration Date	:	02/05/2019
Last Update Date	:	02/05/2019

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Directions to “ MR. PATRICK DENNIS LAVALLIE ” Practice Location

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