Provider Demographics
NPI:1508160847
Name:GITLEVICH, LYUDMILA I (PTA)
Entity Type:Individual
Prefix:MRS
First Name:LYUDMILA
Middle Name:I
Last Name:GITLEVICH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18300 CREEKS BEND DR
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-6100
Mailing Address - Country:US
Mailing Address - Phone:952-465-1545
Mailing Address - Fax:
Practice Address - Street 1:800 BOONE AVE N
Practice Address - Street 2:SUITE 200
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55345-6100
Practice Address - Country:US
Practice Address - Phone:763-417-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-30
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA24225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant