Healthcare Provider Details

I. General information

NPI: 1699698001
Provider Name (Legal Business Name): FAITH GANBREL LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

450 N STANDRIDGE BLVD STE 103
ANNA TX
75409-3443
US

IV. Provider business mailing address

91 MILES LUMBER CO RD
SILVER CREEK MS
39663-2002
US

V. Phone/Fax

Practice location:
  • Phone: 214-432-7733
  • Fax:
Mailing address:
  • Phone: 601-455-2205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number8234
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: