Healthcare Provider Details

I. General information

NPI: 1982103131
Provider Name (Legal Business Name): JESSICA LEWIS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA LASHUN BROWNLOW

II. Dates (important events)

Enumeration Date: 02/02/2018
Last Update Date: 04/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6172 AIRWAYS BLVD STE 122
CHATTANOOGA TN
37421-2915
US

IV. Provider business mailing address

PO BOX 8114
CHATTANOOGA TN
37414-0114
US

V. Phone/Fax

Practice location:
  • Phone: 423-622-1551
  • Fax: 877-856-7133
Mailing address:
  • Phone: 423-622-1551
  • Fax: 877-856-7133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11368
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: