Provider Demographics
NPI:1942689385
Name:LEVI, TERESA
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:LEVI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 HIGHWAY 179A
Mailing Address - Street 2:
Mailing Address - City:WESTVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32464-3049
Mailing Address - Country:US
Mailing Address - Phone:239-682-0656
Mailing Address - Fax:
Practice Address - Street 1:1045 HIGHWAY 179A
Practice Address - Street 2:
Practice Address - City:WESTVILLE
Practice Address - State:FL
Practice Address - Zip Code:32464-3049
Practice Address - Country:US
Practice Address - Phone:239-682-0656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT11540225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist