Provider Demographics
NPI:1407438468
Name:LEVINE, HAILEY (LMT)
Entity Type:Individual
Prefix:
First Name:HAILEY
Middle Name:
Last Name:LEVINE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9037 INDEPENDENCE AVE STE A2
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-7694
Mailing Address - Country:US
Mailing Address - Phone:251-459-0500
Mailing Address - Fax:
Practice Address - Street 1:9037 INDEPENDENCE AVE STE A2
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-7694
Practice Address - Country:US
Practice Address - Phone:251-459-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMT5583172M00000X
225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No172M00000XOther Service ProvidersMechanotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALMT5583OtherLICENSE MASSAGE THERAPY