MEDICARE: MR. DERICK LEVY PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	3349	CO

General Provider Information

NPI Number	:	1235141839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DERICK LEVY PT

Provider Business Mailing Address
First Line	:	3865 CHERRY CREEK NORTH DR
Second Line	:	LL70
City	:	DENVER
State	:	CO
Zip	:	80209-3803
Country	:	US
Telephone Number	:	303-394-3356
Fax Number	:	303-394-3359

Provider Business Practice Location Address
First Line	:	3865 CHERRY CREEK NORTH DR
Second Line	:	LL70
City	:	DENVER
State	:	CO
Zip	:	80209-3803
Country	:	US
Telephone Number	:	303-394-3356
Fax Number	:	303-394-3359

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	07/09/2007

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