Provider Demographics
NPI:1932462736
Name:LAVELLE, REGINA VALERIE
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:VALERIE
Last Name:LAVELLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 N KALAHEO AVE
Mailing Address - Street 2:STE C316
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-1883
Mailing Address - Country:US
Mailing Address - Phone:808-488-5555
Mailing Address - Fax:808-312-6363
Practice Address - Street 1:1188 BISHOP ST
Practice Address - Street 2:STE 3311
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-3301
Practice Address - Country:US
Practice Address - Phone:808-738-5601
Practice Address - Fax:808-536-9187
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI476171100000X
HI1360225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171100000XOther Service ProvidersAcupuncturist