Provider Demographics
NPI:1972994382
Name:LEAVITT, JAMES (ATC)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:LEAVITT
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3992 ANDOVER DR
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-2302
Mailing Address - Country:US
Mailing Address - Phone:989-415-0411
Mailing Address - Fax:
Practice Address - Street 1:3992 ANDOVER DR
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2302
Practice Address - Country:US
Practice Address - Phone:989-415-0411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-08
Last Update Date:2015-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010014192255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer