Healthcare Provider Details

I. General information

NPI: 1881874865
Provider Name (Legal Business Name): DONNA LEWIS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 11/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 WESTERN AVE
LYNN MA
01904-2123
US

IV. Provider business mailing address

34 WESTERN AVE
LYNN MA
01904-2123
US

V. Phone/Fax

Practice location:
  • Phone: 781-913-9173
  • Fax:
Mailing address:
  • Phone: 781-913-9173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: