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General NPI Number Information
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NPI Number | 1841706363
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Entity Type | Individual
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Provider Name | GARY LYNN LEWIS JR. PTA
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Gender | Male
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Dates
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Enumeration Date | 12/20/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 9215 WHITE ROCK TRL
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City | DALLAS
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State | TX
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Zip | 75238-2593
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Country | US
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Telephone | 214-221-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 5451 INDEPENDENCE PKWY APT 2907
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City | PLANO
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State | TX
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Zip | 75023-5441
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Country | US
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Telephone | 903-805-4333
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2127103
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License Number State | TX
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