=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154603801
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CYNTHIA JANE LEWIS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2011
-----------------------------------------------------
Last Update Date | 09/19/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 275 STEWARTS FERRY PIKE
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37214-3325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-231-5110
-----------------------------------------------------
Fax | 615-231-5072
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 275 STEWARTS FERRY PIKE
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37214-3325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-231-5110
-----------------------------------------------------
Fax | 615-231-5072
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | 2223
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------