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General NPI Number Information
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NPI Number | 1356095715
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Entity Type | Organization
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Legal Business Name | JOVIAL LEWIS PEDIATRIC PHYSICAL THERAPY PLLC
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Dates
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Enumeration Date | 02/04/2022
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Last Update Date | 02/04/2022
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Provider Practice Location Address
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Address Line | 5615 251ST ST
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City | LITTLE NECK
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State | NY
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Zip | 11362-2117
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Country | US
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Telephone | 718-427-5585
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Fax | 718-507-4401
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Provider Business Mailing Address
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Address Line | 5301 SKILLMAN AVE APT 3R
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City | WOODSIDE
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State | NY
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Zip | 11377-4121
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Country | US
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Telephone | 718-427-5585
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Fax | 718-507-4401
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST-PEDIATRIC
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Name | MRS. JOVIAL LEWIS
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Credential | PT
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Telephone | 718-427-5585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number |
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License Number State |
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