Provider Demographics
NPI:1548434178
Name:LEVESQUE, ELISE MARIE (MPT)
Entity type:Individual
Prefix:MRS
First Name:ELISE
Middle Name:MARIE
Last Name:LEVESQUE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MS
Other - First Name:ELISE
Other - Middle Name:MARIE
Other - Last Name:GELINAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:30 PECK RD
Mailing Address - Street 2:BLDG #1; SUITE 1101
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-6123
Mailing Address - Country:US
Mailing Address - Phone:860-489-0867
Mailing Address - Fax:860-489-4473
Practice Address - Street 1:30 PECK RD
Practice Address - Street 2:BUILDING #1; SUITE 1101
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-6123
Practice Address - Country:US
Practice Address - Phone:860-489-0867
Practice Address - Fax:860-489-4473
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008286225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist