Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PT12170 | CA |
NPI | 1033313655 |
---|---|
Provider Name | Lorraine Vivienne Levy |
First Address | Del Mar, CA 92014-3905 |
Second Address | San Marcos, CA 92078-4201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2007 |
Last Update Date | 02/12/2021 |