Individual
SHANE LEVENSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2603 LOWER GAINESVILLE RD, STENNIS SPACE CENTER, MS 39529-7099
(228) 813-4000
Mailing address
2603 LOWER GAINESVILLE RD, STENNIS SPACE CENTER, MS 39529-7099
(228) 813-4000
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT0452
MS
Other
Enumeration date
09/10/2015
Last updated
09/10/2015
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