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General NPI Number Information
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NPI Number | 1306578380
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Entity Type | Individual
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Provider Name | KAISHA LEWIS PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 06/28/2022
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Last Update Date | 06/28/2022
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Provider Practice Location Address
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Address Line | 6800 NW 39TH EXPY
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City | BETHANY
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State | OK
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Zip | 73008-2513
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Country | US
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Telephone | 405-789-6711
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Fax |
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Provider Business Mailing Address
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Address Line | 6475 36TH AVE NW APT 434
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City | NORMAN
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State | OK
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Zip | 73072-1330
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Country | US
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Telephone | 602-292-4267
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Fax |
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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 | 6199
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License Number State | OK
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