Healthcare Provider Details

I. General information

NPI: 1821161761
Provider Name (Legal Business Name): BETTINA H. LAVIANA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETTINA HILLI RPT

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 05/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 ROBERTS STREET CONNECTICUT ORTHOPEDIC REHABILITATION ASSOCIATES
EAST HARTFORD CT
06108
US

IV. Provider business mailing address

136 W MAIN ST CORA
NEW BRITAIN CT
06052-1315
US

V. Phone/Fax

Practice location:
  • Phone: 860-290-3788
  • Fax: 860-290-3789
Mailing address:
  • Phone: 860-801-6171
  • Fax: 860-826-4762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number004849
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: