Healthcare Provider Details

I. General information

NPI: 1356865836
Provider Name (Legal Business Name): EMILY ANNETTE LEWIS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY ANNETTE LARSON

II. Dates (important events)

Enumeration Date: 07/27/2017
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4949 KIRSCHLING CT STE 2
STEVENS POINT WI
54481-7044
US

IV. Provider business mailing address

W902 COUNTY ROAD X
MARKESAN WI
53946-7511
US

V. Phone/Fax

Practice location:
  • Phone: 715-544-2322
  • Fax: 715-544-6398
Mailing address:
  • Phone: 920-229-1864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1704224
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: