Provider Demographics
NPI:1477565307
Name:LEVINE, ELLEN HASSERT (PT)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:HASSERT
Last Name:LEVINE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:ELLEN
Other - Middle Name:THOMPSON
Other - Last Name:HASSERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:8 BEAGLE CLUB WAY
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-6114
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5550 KIRKWOOD HWY
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5002
Practice Address - Country:US
Practice Address - Phone:302-995-2100
Practice Address - Fax:302-998-3104
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ100002722251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic