Provider Demographics
NPI:1588813364
Name:LEVESQUE, ANN M (PT)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:LEVESQUE
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 1:109 COLON ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-3661
Mailing Address - Country:US
Mailing Address - Phone:978-927-7668
Mailing Address - Fax:978-927-5687
Practice Address - Street 1:109 COLON ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-3661
Practice Address - Country:US
Practice Address - Phone:978-927-7668
Practice Address - Fax:978-927-5687
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5673225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist