Provider Demographics
NPI:1205925575
Name:LEVY PHYSICAL THERAPY, INC
Entity type:Organization
Organization Name:LEVY PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-927-3883
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:970-927-3883
Mailing Address - Fax:970-927-3907
Practice Address - Street 1:711 E VALLEY RD UNIT 202B
Practice Address - Street 2:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5873174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO7041704OtherAETNA PIN #
CO7041704OtherAETNA PIN #