MEDICARE: ALLYSA BROOKE LEE-LEVINE

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	PT44147	FL
2	225100000X	Physical Therapist	40QA02352900	NJ

General Provider Information

NPI Number	:	1649151432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLYSA BROOKE LEE-LEVINE

Provider Business Mailing Address
First Line	:	3 HONEYSUCKLE CT
Second Line	:
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-2776
Country	:	US
Telephone Number	:	732-613-5151
Fax Number	:

Provider Business Practice Location Address
First Line	:	2259 W HILLSBORO BLVD # A
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33442-1106
Country	:	US
Telephone Number	:	954-725-4160
Fax Number	:

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

Provider Enumeration Date	:	09/09/2025
Last Update Date	:	12/22/2025

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