MEDICARE: AUDREY LEWIS PT, 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	225100000X	Physical Therapist	PTH10996	AL

General Provider Information

NPI Number	:	1598544710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDREY LEWIS PT, DPT

Provider Business Mailing Address
First Line	:	2740 E COLLEGE AVE APT 432
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30030-3147
Country	:	US
Telephone Number	:	256-665-8004
Fax Number	:

Provider Business Practice Location Address
First Line	:	351 THORNTON RD
Second Line	:
City	:	LITHIA SPRINGS
State	:	GA
Zip	:	30122-4122
Country	:	US
Telephone Number	:	770-577-0399
Fax Number	:

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

Provider Enumeration Date	:	09/26/2023
Last Update Date	:	09/26/2023

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