Healthcare Provider Details

I. General information

NPI: 1164609004
Provider Name (Legal Business Name): KIM M LEWIS MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2008
Last Update Date: 01/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 BEISER BLVD SUITE 103
DOVER DE
19904-7793
US

IV. Provider business mailing address

230 BEISER BLVD SUITE 103
DOVER DE
19904-7793
US

V. Phone/Fax

Practice location:
  • Phone: 302-736-0994
  • Fax: 302-736-5529
Mailing address:
  • Phone: 302-736-0994
  • Fax: 302-736-5529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberJ1-0001188
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: