Provider Demographics
NPI:1124216221
Name:LEVASSEUR, JAMES (PTA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:LEVASSEUR
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 ALBION ST
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-1705
Mailing Address - Country:US
Mailing Address - Phone:781-420-6889
Mailing Address - Fax:
Practice Address - Street 1:20 ALBION ST
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-1705
Practice Address - Country:US
Practice Address - Phone:781-420-6889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4065225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant