Active NPI
Glenn Edward Lavallee, MSPT
- Pediatric Physical Therapist
- New Milford, CT
National Provider Identifier
1821242819
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Physical Therapist
- License
- 026269-1
- Practice address
- 2 Grandview LN
New Milford, CT 06776-2344 - Phone
- (860) 355-5101
- NPI assigned
- Nov 5, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | 026269-1 | NY | Primary |
Addresses
Primary practice location
2 Grandview LN
New Milford, CT 06776-2344
Mailing address
2 Grandview LN
New Milford, CT 06776-2344
Phone (860) 355-5101
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 026269-1 | NY | MD | Pediatric Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1225843200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1275004800000",
"number": "1821242819",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2 GRANDVIEW LN",
"city": "NEW MILFORD",
"state": "CT",
"postal_code": "067762344",
"telephone_number": "860-355-5101"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2 GRANDVIEW LN",
"city": "NEW MILFORD",
"state": "CT",
"postal_code": "067762344",
"telephone_number": "860-355-5101"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAVALLEE",
"first_name": "GLENN",
"middle_name": "EDWARD",
"name_prefix": "Mr.",
"credential": "MSPT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-11-05",
"last_updated": "2010-05-28",
"status": "A"
},
"taxonomies": [
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "NY",
"license": "026269-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New Milford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.