MEDICARE: DR. MICHAEL GEORGE LEVRINI DHSC PT ECS

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	2251E1300X	Clinical Electrophysiology Physical Therapist	2305005514	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	259143	OTHER	VA	ANTHEM BC BS PROV NUMBER
3	299977	OTHER	VA	MAMSI PROVIDER #
4	7740445	OTHER	VA	AETNA PROVIDER NUMBER

General Provider Information

NPI Number	:	1366594426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL GEORGE LEVRINI DHSC PT ECS

Provider Business Mailing Address
First Line	:	11670 BENNINGTON WOODS RD
Second Line	:
City	:	RESTON
State	:	VA
Zip	:	20194-1610
Country	:	US
Telephone Number	:	703-787-8434
Fax Number	:	703-787-8434

Provider Business Practice Location Address
First Line	:	11670 BENNINGTON WOODS RD
Second Line	:
City	:	RESTON
State	:	VA
Zip	:	20194-1610
Country	:	US
Telephone Number	:	703-787-8434
Fax Number	:	703-787-8434

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

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	07/01/2016

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