Healthcare Provider Details

I. General information

NPI: 1407438468
Provider Name (Legal Business Name): HAILEY LEVINE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2021
Last Update Date: 04/28/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9037 INDEPENDENCE AVE STE A2
DAPHNE AL
36526-7694
US

IV. Provider business mailing address

9037 INDEPENDENCE AVE STE A2
DAPHNE AL
36526-7694
US

V. Phone/Fax

Practice location:
  • Phone: 251-459-0500
  • Fax:
Mailing address:
  • Phone: 251-459-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberMT5583
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: