Provider Demographics
NPI:1033420963
Name:LEVISON, KAREN ANN (MSHSA, PTA)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:LEVISON
Suffix:
Gender:F
Credentials:MSHSA, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 204
Mailing Address - Street 2:
Mailing Address - City:INDIAN LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12842-0204
Mailing Address - Country:US
Mailing Address - Phone:518-648-0448
Mailing Address - Fax:
Practice Address - Street 1:477 ADIRONDACK LAKE ROAD
Practice Address - Street 2:
Practice Address - City:INDIAN LAKE
Practice Address - State:NY
Practice Address - Zip Code:12842-0204
Practice Address - Country:US
Practice Address - Phone:518-648-0448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001072-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant