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General NPI Number Information
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NPI Number | 1790702272
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Entity Type | Individual
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Provider Name | LARRY WAYNE LEWIS JR. PT
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Gender | Male
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 09/11/2016
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Provider Practice Location Address
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Address Line | 322 NUWAY CIR
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City | LENOIR
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State | NC
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Zip | 28645-3656
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Country | US
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Telephone | 828-758-7326
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Fax | 828-757-0938
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Provider Business Mailing Address
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Address Line | 5383 ANTLER CREEK DR
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City | GRANITE FALLS
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State | NC
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Zip | 28630-8813
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Country | US
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Telephone | 828-244-1073
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Fax | 828-313-0373
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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 | 7268
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License Number State | NC
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