Provider Demographics
NPI:1134329824
Name:LEVESQUE, MICHAELA J (PT)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:J
Last Name:LEVESQUE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MICHAELA
Other - Middle Name:J
Other - Last Name:TIBBETTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:148 EAST AVE
Mailing Address - Street 2:SUITE 2M
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-5721
Mailing Address - Country:US
Mailing Address - Phone:203-866-5458
Mailing Address - Fax:203-866-3014
Practice Address - Street 1:9B FIELDSTONE CMNS
Practice Address - Street 2:
Practice Address - City:TOLLAND
Practice Address - State:CT
Practice Address - Zip Code:06084-3418
Practice Address - Country:US
Practice Address - Phone:860-870-9800
Practice Address - Fax:860-870-9806
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008134225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist