Healthcare Provider Details

I. General information

NPI: 1699895763
Provider Name (Legal Business Name): KRISTIN MARIE LEWIS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 S MAIN ST STE C
LONGMONT CO
80501-1714
US

IV. Provider business mailing address

205 S MAIN ST STE C
LONGMONT CO
80501-1714
US

V. Phone/Fax

Practice location:
  • Phone: 303-702-1612
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0018568
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: