MEDICARE: LEV3L PERFORMANCE PHYSICAL THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1194443051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEV3L PERFORMANCE PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	PO BOX 2334
Second Line	:
City	:	WATFORD CITY
State	:	ND
Zip	:	58854-2334
Country	:	US
Telephone Number	:	918-520-7151
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 12TH ST SE
Second Line	:
City	:	WATFORD CITY
State	:	ND
Zip	:	58854-6722
Country	:	US
Telephone Number	:	918-520-7151
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LAURA WHITELEY
Credential	:	DPT
Telephone Number	:	918-520-7151

Provider Enumeration Date	:	08/17/2022
Last Update Date	:	01/06/2023

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