Healthcare Provider Details

I. General information

NPI: 1659969848
Provider Name (Legal Business Name): NEU-LEVEL THERAPY AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2021
Last Update Date: 01/04/2021
Certification Date: 11/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MILLBROOK VILLAGE DR STE C
TYRONE GA
30290-3603
US

IV. Provider business mailing address

14 HIGHBRANCH WAY
NEWNAN GA
30265-6217
US

V. Phone/Fax

Practice location:
  • Phone: 954-303-4670
  • Fax:
Mailing address:
  • Phone: 770-502-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DR. PAULETTE LEWIS
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: MPT, DPT
Phone: 954-303-4670