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1790702272 NPI number — LARRY WAYNE LEWIS JR. PT

NPI Number: 1790702272
Health Care Provider/Practitioner: LARRY WAYNE LEWIS JR. PT

Information about “1790702272” NPI (LARRY WAYNE LEWIS JR. PT) exists in 1790702272 in HTML format HTML  |  1790702272 in plain Text format TXT  |  1790702272 in PDF (Portable Document Format) PDF  |  1790702272 in an XML format XML  formats.

NPI Number : 1790702272 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1790702272",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LEWIS",
    "FirstName": "LARRY",
    "MiddleName": "WAYNE",
    "NamePrefix": "MR.",
    "NameSuffix": "JR.",
    "Credential": "PT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5383 ANTLER CREEK DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GRANITE FALLS",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "28630-8813",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "828-244-1073",
    "MailingAddressFaxNumber": "828-313-0373",
    "FirstLinePracticeLocationAddress": "322 NUWAY CIR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LENOIR",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "28645-3656",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "828-758-7326",
    "PracticeLocationAddressFaxNumber": "828-757-0938",
    "EnumerationDate": "07/17/2006",
    "LastUpdateDate": "09/11/2016",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "225100000X",
        "TaxonomyName": "Physical Therapist",
        "LicenseNumber": "7268",
        "LicenseNumberStateCode": "NC",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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