Healthcare Provider Details

I. General information

NPI: 1144538018
Provider Name (Legal Business Name): PATRICK HOWARD LEWIS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 09/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 RANDOLPH ST
RADFORD VA
24141-2430
US

IV. Provider business mailing address

1940 SEYMOUR DR
BLACKSBURG VA
24060-0964
US

V. Phone/Fax

Practice location:
  • Phone: 540-633-3708
  • Fax:
Mailing address:
  • Phone: 970-270-8549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305206377
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: