Provider Demographics
NPI:1801933304
Name:LEVIE, HEATHER ANN (PT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANN
Last Name:LEVIE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 OAK LAWN CT APT 103
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60195-5125
Mailing Address - Country:US
Mailing Address - Phone:630-390-8643
Mailing Address - Fax:
Practice Address - Street 1:17W718 BUTTERFIELD RD # 305
Practice Address - Street 2:
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-4834
Practice Address - Country:US
Practice Address - Phone:630-202-0405
Practice Address - Fax:630-620-9220
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.0111262251P0200X
IL070-011126225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL100044415-62762-01Medicare ID - Type Unspecified