Provider Demographics
NPI:1336362441
Name:LEVY, RUSSELL KEITH (MSPT)
Entity type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:KEITH
Last Name:LEVY
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8140 W WATERS AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-1859
Mailing Address - Country:US
Mailing Address - Phone:813-885-1613
Mailing Address - Fax:
Practice Address - Street 1:8140 W WATERS AVE
Practice Address - Street 2:SUITE D
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-1859
Practice Address - Country:US
Practice Address - Phone:813-885-1613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19830225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist