Provider Demographics
NPI:1518374321
Name:LEVINGSTON, ALBERT (PTA)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:
Last Name:LEVINGSTON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S 21ST ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-3762
Mailing Address - Country:US
Mailing Address - Phone:719-633-3479
Mailing Address - Fax:719-634-1112
Practice Address - Street 1:600 S 21ST ST
Practice Address - Street 2:SUITE 130
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-3762
Practice Address - Country:US
Practice Address - Phone:719-633-3479
Practice Address - Fax:719-634-1112
Is Sole Proprietor?:No
Enumeration Date:2014-07-14
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTA.0012780225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant