MEDICARE: EDI LEVISMAN 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	PT22774	CA

General Provider Information

NPI Number	:	1548356413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDI LEVISMAN PT

Provider Business Mailing Address
First Line	:	9730 WILSHIRE BLVD. SUITE 200
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-2004
Country	:	US
Telephone Number	:	310-278-0204
Fax Number	:	310-278-0171

Provider Business Practice Location Address
First Line	:	9730 WILSHIRE BLVD. SUITE 200
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-2004
Country	:	US
Telephone Number	:	310-278-0204
Fax Number	:	310-278-0171

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	02/25/2011

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Directions to “ EDI LEVISMAN PT” Practice Location

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