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General NPI Number Information
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NPI Number | 1659232163
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Entity Type | Organization
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Legal Business Name | LAVENDURA LLC
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Dates
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Enumeration Date | 11/24/2025
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 1265 S LAKE PARK AVE STE A
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City | HOBART
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State | IN
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Zip | 46342-5961
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Country | US
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Telephone | 219-281-6824
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Fax |
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Provider Business Mailing Address
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Address Line | 3618 W 80TH LN # 1091
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City | MERRILLVILLE
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State | IN
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Zip | 46410-5061
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Country | US
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Telephone | 219-281-6824
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | JOHN ADAM JEFFREY
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Credential | LMT
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Telephone | 708-441-9998
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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