Healthcare Provider Details

I. General information

NPI: 1790702272
Provider Name (Legal Business Name): LARRY WAYNE LEWIS JR. PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 09/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 NUWAY CIR
LENOIR NC
28645-3656
US

IV. Provider business mailing address

5383 ANTLER CREEK DR
GRANITE FALLS NC
28630-8813
US

V. Phone/Fax

Practice location:
  • Phone: 828-758-7326
  • Fax: 828-757-0938
Mailing address:
  • Phone: 828-244-1073
  • Fax: 828-313-0373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7268
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: