Provider Demographics
NPI:1376654723
Name:LEVINS, STEPHEN MATTHEW (PT, MSC, OCS)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:MATTHEW
Last Name:LEVINS
Suffix:
Gender:M
Credentials:PT, MSC, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7932 SUMMA AVE STE B3
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3416
Mailing Address - Country:US
Mailing Address - Phone:225-769-9203
Mailing Address - Fax:225-769-9205
Practice Address - Street 1:7932 SUMMA AVE STE B3
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3416
Practice Address - Country:US
Practice Address - Phone:225-769-9203
Practice Address - Fax:225-769-9205
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA02644F225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA02644FOtherPT LICENSE NUMBER
LA4C623Medicare ID - Type UnspecifiedMEDICARE NUMBER