Provider Demographics
NPI:1174647770
Name:LEVANDUSKI, LEE C (PT)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:C
Last Name:LEVANDUSKI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11014 4TH AVE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34212-1615
Mailing Address - Country:US
Mailing Address - Phone:941-708-9555
Mailing Address - Fax:941-708-5465
Practice Address - Street 1:11014 4TH AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34212-1615
Practice Address - Country:US
Practice Address - Phone:941-708-9555
Practice Address - Fax:941-708-5465
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT17949225100000X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT17949OtherSTATE LICENSE