Healthcare Provider Details

I. General information

NPI: 1922312362
Provider Name (Legal Business Name): RICHARD GREGORY LEWIS P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 07/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4310 JAMES CASEY ST SUITE 3C
AUSTIN TX
78745-1251
US

IV. Provider business mailing address

PO BOX 42680
AUSTIN TX
78704-0043
US

V. Phone/Fax

Practice location:
  • Phone: 512-441-6008
  • Fax: 512-326-2805
Mailing address:
  • Phone: 512-441-6008
  • Fax: 512-326-2805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1164803
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: