Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT17949 | FL |
N | 2251S0007X | Physical Therapist - Sports | PT17949 | FL |
Y | 2251X0800X | Physical Therapist - Orthopedic | PT17949 | FL |
NPI | 1174647770 |
---|---|
Provider Name | Lee C Levanduski |
First Address | Bradenton, FL 34212-1615 |
Second Address | Bradenton, FL 34212-1615 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 16/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PT17949 | STATE LICENSE (01) | FL |