Provider Demographics
NPI:1609837426
Name:LEVAS, MICHAEL G (PT OCS MDT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:LEVAS
Suffix:
Gender:M
Credentials:PT OCS MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 ORCHARD WOOD RD
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5657
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9404 GENESEE AVE
Practice Address - Street 2:STE 310
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037
Practice Address - Country:US
Practice Address - Phone:858-455-1195
Practice Address - Fax:858-455-7101
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT7178225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WPT7178AMedicare ID - Type Unspecified
WPT7178Medicare ID - Type Unspecified
WPT7178CMedicare ID - Type Unspecified
WPT7178DMedicare ID - Type Unspecified
WPT7178BMedicare ID - Type Unspecified
WPT7178FMedicare ID - Type Unspecified
WPT7178EMedicare ID - Type Unspecified