Healthcare Provider Details

I. General information

NPI: 1407890577
Provider Name (Legal Business Name): ERIN R. LEWIS M.S., P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date: 08/22/2017
Reactivation Date: 12/18/2019

III. Provider practice location address

4 GROVE STREET
MAYFLOWER AR
72106
US

IV. Provider business mailing address

P.O. BOX 933
GREENBRIER AR
72058
US

V. Phone/Fax

Practice location:
  • Phone: 501-470-0387
  • Fax:
Mailing address:
  • Phone: 501-581-6045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2460
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: