Provider Demographics
NPI:1821161761
Name:LAVIANA, BETTINA H (PT)
Entity Type:Individual
Prefix:MS
First Name:BETTINA
Middle Name:H
Last Name:LAVIANA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:BETTINA
Other - Middle Name:
Other - Last Name:HILLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPT
Mailing Address - Street 1:136 W MAIN ST
Mailing Address - Street 2:CORA
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052-1315
Mailing Address - Country:US
Mailing Address - Phone:860-801-6171
Mailing Address - Fax:860-826-4762
Practice Address - Street 1:290 ROBERTS STREET
Practice Address - Street 2:CONNECTICUT ORTHOPEDIC REHABILITATION ASSOCIATES
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108
Practice Address - Country:US
Practice Address - Phone:860-290-3788
Practice Address - Fax:860-290-3789
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004849225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist