Healthcare Provider Details

I. General information

NPI: 1134329824
Provider Name (Legal Business Name): MICHAELA JANE LEVESQUE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHAELA JANE TIBBETTS

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 GALLBERRY LN
WAXHAW NC
28173-0161
US

IV. Provider business mailing address

123 BERGERON WAY
CARY NC
27519-6669
US

V. Phone/Fax

Practice location:
  • Phone: 704-649-4509
  • Fax:
Mailing address:
  • Phone: 508-642-5255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP15473
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: