Provider Demographics
NPI:1548356413
Name:LEVISMAN, EDI (PT)
Entity type:Individual
Prefix:
First Name:EDI
Middle Name:
Last Name:LEVISMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9730 WILSHIRE BLVD. SUITE 200
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-2004
Mailing Address - Country:US
Mailing Address - Phone:310-278-0204
Mailing Address - Fax:310-278-0171
Practice Address - Street 1:9730 WILSHIRE BLVD. SUITE 200
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-2004
Practice Address - Country:US
Practice Address - Phone:310-278-0204
Practice Address - Fax:310-278-0171
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT22774225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist