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General NPI Number Information
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NPI Number | 1275630386
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Entity Type | Individual
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Provider Name | MANDI L LEWIS PT
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Gender | Female
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 21756 STATE ROAD 54 #102
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City | LUTZ
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State | FL
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Zip | 33549-6921
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Country | US
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Telephone | 813-948-8443
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Fax | 813-909-2036
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Provider Business Mailing Address
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Address Line | 21756 STATE ROAD 54 #102
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City | LUTZ
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State | FL
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Zip | 33549-6921
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Country | US
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Telephone | 813-948-8443
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Fax | 813-909-2036
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT20237
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License Number State | FL
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