Provider Demographics
NPI:1285413864
Name:MISHRA, LAVNIKA ANAND (DPT, MPT)
Entity type:Individual
Prefix:MS
First Name:LAVNIKA
Middle Name:ANAND
Last Name:MISHRA
Suffix:
Gender:F
Credentials:DPT, MPT
Other - Prefix:
Other - First Name:LAVNIKA
Other - Middle Name:
Other - Last Name:DUBEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1004 121ST AVE SE
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-9009
Mailing Address - Country:US
Mailing Address - Phone:425-469-7388
Mailing Address - Fax:
Practice Address - Street 1:3707, PROVIDENCE POINT SE SUITE D
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029
Practice Address - Country:US
Practice Address - Phone:425-620-4384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT612635132251N0400X, 2251P0200X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics