Provider Demographics
NPI:1871929281
Name:JVL INTERNATIONAL, INC
Entity type:Organization
Organization Name:JVL INTERNATIONAL, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:VAN
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-521-3234
Mailing Address - Street 1:199 SHIRLEY AVE
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-3258
Mailing Address - Country:US
Mailing Address - Phone:781-629-7110
Mailing Address - Fax:781-629-4754
Practice Address - Street 1:199 SHIRLEY AVE
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-3258
Practice Address - Country:US
Practice Address - Phone:781-629-7110
Practice Address - Fax:781-629-4754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-17
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA763261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy