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General NPI Number Information
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NPI Number | 1366742553
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Entity Type | Individual
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Provider Name | KIZMI LEVENS OLSON P.T.
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Gender | Female
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Dates
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Enumeration Date | 10/22/2010
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Last Update Date | 02/04/2014
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Provider Practice Location Address
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Address Line | 8128 E FLORENTINE RD STE A
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-8484
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Country | US
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Telephone | 928-775-6811
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Fax |
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Provider Business Mailing Address
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Address Line | 2625 E. OLD MINER RD
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City | PRESCOTT
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State | AZ
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Zip | 86303
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Country | US
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Telephone | 620-714-0451
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Fax |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 10229
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License Number State | AZ
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