Provider Demographics
NPI:1821262379
Name:LEVY, MICHAEL SCOTT (PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SCOTT
Last Name:LEVY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 PTARMIGON CT
Mailing Address - Street 2:
Mailing Address - City:BASALT
Mailing Address - State:CO
Mailing Address - Zip Code:81621-8201
Mailing Address - Country:US
Mailing Address - Phone:970-927-2335
Mailing Address - Fax:970-927-3907
Practice Address - Street 1:711 E VALLEY RD
Practice Address - Street 2:SUITE 202B
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621-8370
Practice Address - Country:US
Practice Address - Phone:970-927-3883
Practice Address - Fax:970-927-3907
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5873225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO802802Medicare PIN