Individual
LAVINA JETHANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
401 15TH AVE SE, PUYALLUP, WA 98372-3715
(253) 697-3265
(931) 208-3645
Mailing address
39 COUNTRY VIEW DR, FREEHOLD, NJ 07728-9019
(732) 625-0072
(931) 208-3645
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
BP10069716
TX
2081P0004X
Spinal Cord Injury Medicine Physician
Primary
MD61281055
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/28/2016
Last updated
07/21/2022
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