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General NPI Number Information
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NPI Number | 1639885874
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Entity Type | Organization
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Legal Business Name | KENDRA LEVI DO, LLC
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Dates
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Enumeration Date | 01/30/2023
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Last Update Date | 01/30/2023
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Provider Practice Location Address
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Address Line | 502 BULLOCKS POINT AVE
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City | RIVERSIDE
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State | RI
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Zip | 02915-3504
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Country | US
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Telephone | 772-919-5068
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Fax |
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Provider Business Mailing Address
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Address Line | 139 LANGDON ST
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City | PROVIDENCE
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State | RI
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Zip | 02904-1108
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Country | US
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Telephone | 772-919-5068
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | KENDRA LEVI
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Credential | DO
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Telephone | 772-919-5068
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number |
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License Number State |
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