Provider Demographics
NPI:1770357386
Name:LEVAKOV, ANDREW (PT, DPT)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:LEVAKOV
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-2621
Mailing Address - Country:US
Mailing Address - Phone:516-599-8734
Mailing Address - Fax:516-599-8730
Practice Address - Street 1:225 MERRICK RD
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-2621
Practice Address - Country:US
Practice Address - Phone:516-599-8734
Practice Address - Fax:516-599-8730
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-14
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051632225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist