MEDICARE: ALEC LEVESQUE

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	11872	AZ
2	225100000X	Physical Therapist	27445	MD

General Provider Information

NPI Number	:	1316303290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEC LEVESQUE

Provider Business Mailing Address
First Line	:	790 REMINGTON BLVD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4909
Country	:	US
Telephone Number	:	630-296-2222
Fax Number	:

Provider Business Practice Location Address
First Line	:	4853 PULASKI HWY STE 315
Second Line	:
City	:	PERRYVILLE
State	:	MD
Zip	:	21903-1606
Country	:	US
Telephone Number	:	443-693-8000
Fax Number	:	410-642-2581

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

Provider Enumeration Date	:	01/08/2016
Last Update Date	:	05/15/2019

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Directions to “ ALEC LEVESQUE ” Practice Location

Language	Start Address	Practice Location

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