Provider Demographics
NPI:1417323049
Name:LEVASSEUR, STEPHANIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:LEVASSEUR
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17332 VON KARMAN AVE
Mailing Address - Street 2:STE 120
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-6282
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2155 FORD PKWY
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-2799
Practice Address - Country:US
Practice Address - Phone:651-696-5010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42772225100000X
MN12880225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB242431Medicare PIN
CAW17215AMedicare PIN
CAW17215Medicare PIN
CACB242432Medicare PIN