Healthcare Provider Details

I. General information

NPI: 1346907821
Provider Name (Legal Business Name): AMY LEWIS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2021
Last Update Date: 11/19/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 N DALTON ST
BARTLETT TX
76511-4332
US

IV. Provider business mailing address

13527 HARRISGLENN DR APT 3319
PFLUGERVILLE TX
78660-6849
US

V. Phone/Fax

Practice location:
  • Phone: 254-527-3371
  • Fax:
Mailing address:
  • Phone: 512-731-7419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2112940
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: