Healthcare Provider Details

I. General information

NPI: 1639636160
Provider Name (Legal Business Name): LEWIS WINSTON GRAVES JR. PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N MONROE ST APT 728
ARLINGTON VA
22201-2374
US

IV. Provider business mailing address

801 N MONROE ST APT 728
ARLINGTON VA
22201-2374
US

V. Phone/Fax

Practice location:
  • Phone: 540-840-2401
  • Fax:
Mailing address:
  • Phone: 540-840-2401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number45-4005110
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: