=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477709558
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSHUA P LEVY L.M.T.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2008
-----------------------------------------------------
Last Update Date | 08/08/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14910 MAIN ST
-----------------------------------------------------
City | ALACHUA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32615-8591
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-462-1843
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1610 NE 15TH TER
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32609-3970
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-403-3254
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 53113
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------