Provider Demographics
NPI:1043442296
Name:D'ORVILLIERS, LARA DANIELLE (MED, ATC)
Entity type:Individual
Prefix:
First Name:LARA
Middle Name:DANIELLE
Last Name:D'ORVILLIERS
Suffix:
Gender:F
Credentials:MED, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 YORK ST
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-4659
Mailing Address - Country:US
Mailing Address - Phone:303-853-1244
Mailing Address - Fax:303-853-1295
Practice Address - Street 1:9000 YORK ST
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4659
Practice Address - Country:US
Practice Address - Phone:303-853-1244
Practice Address - Fax:303-853-1295
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT001309002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer