Healthcare Provider Details

I. General information

NPI: 1760159255
Provider Name (Legal Business Name): ROBERT LEWIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 WYOMING AVE
WEST PITTSTON PA
18643-2742
US

IV. Provider business mailing address

909 WYOMING AVE
WEST PITTSTON PA
18643-2742
US

V. Phone/Fax

Practice location:
  • Phone: 570-905-2229
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT034309
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: