Provider Demographics
NPI:1669415519
Name:LEVITT, KATHLEEN LOUISE (RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:LOUISE
Last Name:LEVITT
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3998 RED LION RD
Mailing Address - Street 2:NUTRITION CENTER
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-1436
Mailing Address - Country:US
Mailing Address - Phone:215-612-4863
Mailing Address - Fax:215-612-5302
Practice Address - Street 1:3998 RED LION RD
Practice Address - Street 2:NUTRITION CENTER
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1436
Practice Address - Country:US
Practice Address - Phone:215-612-4863
Practice Address - Fax:215-612-5302
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003162133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100508Medicare ID - Type Unspecified
PAQ68462Medicare UPIN