Provider Demographics
NPI:1871603761
Name:LEVY, RAANAN (PT)
Entity type:Individual
Prefix:MR
First Name:RAANAN
Middle Name:
Last Name:LEVY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8758 SHUMARD OAK DR
Mailing Address - Street 2:
Mailing Address - City:ROSHARON
Mailing Address - State:TX
Mailing Address - Zip Code:77583-5620
Mailing Address - Country:US
Mailing Address - Phone:973-449-4935
Mailing Address - Fax:
Practice Address - Street 1:2637 LAZY BEND ST STE 101
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-1007
Practice Address - Country:US
Practice Address - Phone:281-485-4144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00768800225100000X
TX1391782225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ038773-PDZMedicare ID - Type UnspecifiedPHYSICAL THERAPY