Healthcare Provider Details

I. General information

NPI: 1073644696
Provider Name (Legal Business Name): DONNA DIANE LEWIS PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 N TYLER ST
LITTLE ROCK AR
72205-3535
US

IV. Provider business mailing address

1320 ROBB CT
LITTLE ROCK AR
72223-6500
US

V. Phone/Fax

Practice location:
  • Phone: 501-664-2961
  • Fax: 501-664-6208
Mailing address:
  • Phone: 501-821-9980
  • Fax: 501-664-6208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number380
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: