MEDICARE: KATHLEEN EVA LEWIS PHYSICAL THERAPIST

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	5210	OH
2	225100000X	Physical Therapist	PT005210	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700296282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN EVA LEWIS PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	1824 CORONADO AVE.
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44504-1307
Country	:	US
Telephone Number	:	330-747-0822
Fax Number	:

Provider Business Practice Location Address
First Line	:	1824 CORONADO AVE.
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44504-1307
Country	:	US
Telephone Number	:	330-747-0822
Fax Number	:

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

Provider Enumeration Date	:	05/06/2014
Last Update Date	:	02/16/2016

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