MEDICARE: JOCELYN LYSCHELL LEWIS DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251P0200X	Pediatric Physical Therapist	40QA01168900	NJ
2	225100000X	Physical Therapist	40QA01168900	NJ

General Provider Information

NPI Number	:	1023220035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOCELYN LYSCHELL LEWIS DPT

Provider Business Mailing Address
First Line	:	310 FAIRVIEW AVE.
Second Line	:
City	:	WEST BERLIN
State	:	NJ
Zip	:	08091
Country	:	US
Telephone Number	:	856-768-1407
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 NORTHPOINTE CIR
Second Line	:	SUITE 302
City	:	SEVEN FIELDS
State	:	PA
Zip	:	16046-7861
Country	:	US
Telephone Number	:	888-426-5430
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	01/28/2010

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