Provider Demographics
NPI:1649151432
Name:LEE-LEVINE, ALLYSA BROOKE
Entity type:Individual
Prefix:
First Name:ALLYSA
Middle Name:BROOKE
Last Name:LEE-LEVINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALLYSA
Other - Middle Name:BROOKE
Other - Last Name:LEE-LEVINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3 HONEYSUCKLE CT
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-2776
Mailing Address - Country:US
Mailing Address - Phone:732-613-5151
Mailing Address - Fax:
Practice Address - Street 1:5901 MACARTHUR BLVD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-2541
Practice Address - Country:US
Practice Address - Phone:202-349-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02352900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty