=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225654155
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEVI FRAME
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2020
-----------------------------------------------------
Last Update Date | 08/25/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | E8323 COUNTY RD E
-----------------------------------------------------
City | ELK MOUND
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54739-9284
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-898-8453
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | E8323 COUNTY RD E # SOUTH
-----------------------------------------------------
City | ELK MOUND
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54739-9284
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-898-8453
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 15319
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 11815
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------