Healthcare Provider Details

I. General information

NPI: 1316089683
Provider Name (Legal Business Name): ALISA L LEVANDOSKI PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALISA I LEVANDOSKI PT

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 06/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 COORS BLVD NW STE 100
ALBUQUERQUE NM
87120-1173
US

IV. Provider business mailing address

2929 COORS BLVD NW STE 100
ALBUQUERQUE NM
87120-1173
US

V. Phone/Fax

Practice location:
  • Phone: 505-239-8969
  • Fax: 866-447-8129
Mailing address:
  • Phone: 505-239-8969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2775
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: