Healthcare Provider Details

I. General information

NPI: 1174647770
Provider Name (Legal Business Name): LEE C LEVANDUSKI PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 11/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11014 4TH AVE E
BRADENTON FL
34212-1615
US

IV. Provider business mailing address

11014 4TH AVE E
BRADENTON FL
34212-1615
US

V. Phone/Fax

Practice location:
  • Phone: 941-708-9555
  • Fax: 941-708-5465
Mailing address:
  • Phone: 941-708-9555
  • Fax: 941-708-5465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT17949
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT17949
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT17949
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: