Individual
MARK A. LEAVITT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.T., CFP
Contact information
Practice address
69 ELM ST STE 204, CAMDEN, ME 04843-1954
(207) 798-1195
Mailing address
69 ELM ST, STE 204, CAMDEN, ME 04843-1954
(207) 798-1195
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT1050
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011457
BCBS
ME
05
—
127700000
—
ME
01
—
2111062
AETNA
ME
01
—
415407
TUFTS
ME
01
—
M21444
CIGNA
ME
Enumeration date
11/16/2006
Last updated
03/18/2016
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