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NPI Code Detail

MEDICARE: NICHOLLE LEWIS PT, DPT

MEDICARE: NICHOLLE LEWIS PT, DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistP22481NC

General Provider Information

NPI Number : 1033980446
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICHOLLE LEWIS PT, DPT
Provider Business Mailing Address
First Line : 10736 TIGERTON LN
Second Line :
City : CHARLOTTE
State : NC
Zip : 28269-1450
Country : US
Telephone Number : 843-814-9396
Fax Number :
Provider Business Practice Location Address
First Line : 101 E W T HARRIS BLVD STE 5001
Second Line :
City : CHARLOTTE
State : NC
Zip : 28262-3574
Country : US
Telephone Number : 704-863-5780
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2024
Last Update Date : 01/15/2024

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