Provider Demographics
NPI:1790183101
Name:LEVY, LOUISE CORINNE (LMT)
Entity Type:Individual
Prefix:MS
First Name:LOUISE
Middle Name:CORINNE
Last Name:LEVY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 PIONEER DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-4141
Mailing Address - Country:US
Mailing Address - Phone:928-458-4340
Mailing Address - Fax:
Practice Address - Street 1:172 E MERRITT ST
Practice Address - Street 2:SUITE A
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-2026
Practice Address - Country:US
Practice Address - Phone:928-458-4340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-17
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-14977172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist