Provider Demographics
NPI:1235215823
Name:LEVEQUE, MATTHEW DOMINIC (PT, MPT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DOMINIC
Last Name:LEVEQUE
Suffix:
Gender:M
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 N TENAYA WAY STE 180
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-1110
Mailing Address - Country:US
Mailing Address - Phone:702-860-3885
Mailing Address - Fax:717-635-3779
Practice Address - Street 1:2650 N TENAYA WAY STE 180
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-1110
Practice Address - Country:US
Practice Address - Phone:702-240-2952
Practice Address - Fax:702-243-0482
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1446225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1446OtherLICENSE #