Basic Information
| Provider Information | |||||||||
| NPI: | 1205314846 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEBOVITZ | ||||||||
| FirstName: | CARL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1235 HOGANSVILLE RD APT 628 | ||||||||
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| City: | LAGRANGE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302416616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014642838 | ||||||||
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| Practice Location | |||||||||
| Address1: | 285 GOVERNOR ST | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029063237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4012760800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2018 | ||||||||
| LastUpdateDate: | 10/08/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.