Provider Demographics
NPI:1578750832
Name:LEVANDER, MARY ANNE (PT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANNE
Last Name:LEVANDER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 SCHILLING DR
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-1525
Mailing Address - Country:US
Mailing Address - Phone:219-864-9728
Mailing Address - Fax:
Practice Address - Street 1:5241 FOUNTAIN DR
Practice Address - Street 2:SUITE E
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-5323
Practice Address - Country:US
Practice Address - Phone:219-757-5241
Practice Address - Fax:219-757-5242
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05001447A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist