Provider Demographics
NPI:1326233123
Name:LEVEA, KATHLEEN W (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:W
Last Name:LEVEA
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 COURTSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-2673
Mailing Address - Country:US
Mailing Address - Phone:585-202-3034
Mailing Address - Fax:
Practice Address - Street 1:17 COURTSHIRE LN
Practice Address - Street 2:
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-2673
Practice Address - Country:US
Practice Address - Phone:585-202-3034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015354225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY182044GGOtherPREFERRED CARE