Provider Demographics
NPI:1194614396
Name:LEVY, COURTNEY GRACE
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:GRACE
Last Name:LEVY
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2159 RED OAK DR
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60073-9550
Mailing Address - Country:US
Mailing Address - Phone:224-358-9353
Mailing Address - Fax:
Practice Address - Street 1:2159 RED OAK DR
Practice Address - Street 2:
Practice Address - City:ROUND LAKE
Practice Address - State:IL
Practice Address - Zip Code:60073-9550
Practice Address - Country:US
Practice Address - Phone:224-358-9353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer