MEDICARE: MATTHEW DOMINIC LEVEQUE PT, MPT

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	1446	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1446	OTHER	NV	LICENSE #

General Provider Information

NPI Number	:	1235215823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW DOMINIC LEVEQUE PT, MPT

Provider Business Mailing Address
First Line	:	2650 N TENAYA WAY STE 180
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-1110
Country	:	US
Telephone Number	:	702-860-3885
Fax Number	:	717-635-3779

Provider Business Practice Location Address
First Line	:	2650 N TENAYA WAY STE 180
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-1110
Country	:	US
Telephone Number	:	702-240-2952
Fax Number	:	702-243-0482

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

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	02/28/2018

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