Provider Demographics
NPI:1316089683
Name:LEVANDOSKI, ALISA L (PT)
Entity type:Individual
Prefix:
First Name:ALISA
Middle Name:L
Last Name:LEVANDOSKI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ALISA
Other - Middle Name:I
Other - Last Name:LEVANDOSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:2929 COORS BLVD NW STE 100
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1173
Mailing Address - Country:US
Mailing Address - Phone:505-239-8969
Mailing Address - Fax:
Practice Address - Street 1:2929 COORS BLVD NW STE 100
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1173
Practice Address - Country:US
Practice Address - Phone:505-239-8969
Practice Address - Fax:866-447-8129
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2775174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist