MEDICARE: JUSTIN DAVID LEVA PT, DPT

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	225100000X	Physical Therapist	P19141	NC
2	225100000X	Physical Therapist	043247	NY

General Provider Information

NPI Number	:	1508348814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN DAVID LEVA PT, DPT

Provider Business Mailing Address
First Line	:	2675 COURT DR
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28054-1478
Country	:	US
Telephone Number	:	704-824-7800
Fax Number	:	704-824-2822

Provider Business Practice Location Address
First Line	:	13024 EASTFIELD RD STE A600
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-6604
Country	:	US
Telephone Number	:	980-288-5440
Fax Number	:	704-727-0946

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2018
Last Update Date	:	06/15/2022

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