Provider Demographics
NPI:1881413318
Name:LEVITATE PHYSICAL THERAPY AND SPORTS PERFORMANCE
Entity type:Organization
Organization Name:LEVITATE PHYSICAL THERAPY AND SPORTS PERFORMANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHALE
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:HAMLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, PT
Authorized Official - Phone:714-202-7424
Mailing Address - Street 1:737 S STATE COLLEGE BLVD STE 90
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-5128
Mailing Address - Country:US
Mailing Address - Phone:714-202-7424
Mailing Address - Fax:
Practice Address - Street 1:737 S STATE COLLEGE BLVD STE 90
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-5128
Practice Address - Country:US
Practice Address - Phone:714-202-7424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist