MEDICARE: MEGAN MARIE LEWIS PTA

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	225200000X	Physical Therapy Assistant	2022041247	MO

General Provider Information

NPI Number	:	1124735352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN MARIE LEWIS PTA

Provider Business Mailing Address
First Line	:	1739 ELM CT STE 205206
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65101-4303
Country	:	US
Telephone Number	:	573-681-0447
Fax Number	:

Provider Business Practice Location Address
First Line	:	3600 COUNTRY CLUB DR STE 530B
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65109-1060
Country	:	US
Telephone Number	:	573-606-7100
Fax Number	:

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

Provider Enumeration Date	:	10/27/2022
Last Update Date	:	10/27/2022

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