Provider Demographics
NPI:1396371415
Name:LEVEE, JAMES RUSSELL (PT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:RUSSELL
Last Name:LEVEE
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:PO BOX 594
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:TX
Mailing Address - Zip Code:75792-0594
Mailing Address - Country:US
Mailing Address - Phone:903-952-1471
Mailing Address - Fax:
Practice Address - Street 1:16911 VILLAGE LAKE DR
Practice Address - Street 2:
Practice Address - City:LINDALE
Practice Address - State:TX
Practice Address - Zip Code:75771-5065
Practice Address - Country:US
Practice Address - Phone:903-882-7055
Practice Address - Fax:903-882-7044
Is Sole Proprietor?:No
Enumeration Date:2020-03-20
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1096634225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist