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General NPI Number Information
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NPI Number | 1154689925
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Entity Type | Individual
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Provider Name | LAWRENCE S LEVY P.T.
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Gender | Male
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Dates
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Enumeration Date | 04/30/2012
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Last Update Date | 04/30/2012
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Provider Practice Location Address
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Address Line | 11479 JEFFERSON BLVD
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City | CULVER CITY
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State | CA
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Zip | 90232
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Country | US
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Telephone | 310-313-3939
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Fax | 310-326-7222
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Provider Business Mailing Address
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Address Line | 11479 JEFFERSON BLVD
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City | CULVER CITY
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State | CA
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Zip | 90232
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Country | US
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Telephone | 310-313-3939
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Fax | 310-326-7222
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number | PT#12989
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License Number State | CA
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