Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | PT#12989 | CA |
NPI | 1154689925 |
---|---|
Provider Name | Mr. Lawrence S Levy |
First Address | Culver City, CA 90232 |
Second Address | Culver City, CA 90232 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2012 |
Last Update Date | 30/04/2012 |