MEDICARE: GERALD E LEWIS PT

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
1	225100000X	Physical Therapist	40QA00396700	NJ
2	225100000X	Physical Therapist	PT40349	FL

General Provider Information

NPI Number	:	1114950961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERALD E LEWIS PT

Provider Business Mailing Address
First Line	:	6800 SOUTHPOINT PKWY STE 300
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-8203
Country	:	US
Telephone Number	:	904-604-0640
Fax Number	:	904-634-0203

Provider Business Practice Location Address
First Line	:	1690 US HIGHWAY 1 S STE F
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32084-6024
Country	:	US
Telephone Number	:	904-634-0640
Fax Number	:	904-634-0203

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	09/29/2023

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Directions to “ GERALD E LEWIS PT” Practice Location

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