Provider Demographics
NPI:1114176120
Name:LEAVVITT, CYRIL BUDDY (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:CYRIL
Middle Name:BUDDY
Last Name:LEAVVITT
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 WATER ST
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04443-6332
Mailing Address - Country:US
Mailing Address - Phone:207-343-0727
Mailing Address - Fax:866-426-2811
Practice Address - Street 1:917 BEVILLE RD
Practice Address - Street 2:SUITE G
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-1712
Practice Address - Country:US
Practice Address - Phone:386-756-4395
Practice Address - Fax:866-426-2811
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT3459225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist