Provider Demographics
NPI:1922792571
Name:LEVINE, YISRAEL NACHUM (DPT)
Entity Type:Individual
Prefix:
First Name:YISRAEL
Middle Name:NACHUM
Last Name:LEVINE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6914 HOLABIRD AVE
Mailing Address - Street 2:
Mailing Address - City:DUNDALK
Mailing Address - State:MD
Mailing Address - Zip Code:21222-1747
Mailing Address - Country:US
Mailing Address - Phone:410-284-5441
Mailing Address - Fax:
Practice Address - Street 1:23 CROSSROADS DR STE 300
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5443
Practice Address - Country:US
Practice Address - Phone:410-998-9133
Practice Address - Fax:410-998-9155
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29352225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist