=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477832962
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMANDA LEIGH LEWANDOWSKI DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2011
-----------------------------------------------------
Last Update Date | 08/15/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13011 SUMMERFIELD SQUARE DR
-----------------------------------------------------
City | RIVERVIEW
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33578-7402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-374-2209
-----------------------------------------------------
Fax | 813-374-2211
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 7746
-----------------------------------------------------
City | SAINT PETERSBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33734-7746
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-898-5001
-----------------------------------------------------
Fax | 727-894-0554
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT26537
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------