MEDICARE: LEWY PHYSICAL THERAPY INC

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	01629	LA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5C911	OTHER	LA	MEDICARE PTAN

General Provider Information

NPI Number	:	1154324242
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEWY PHYSICAL THERAPY INC

Provider Business Mailing Address
First Line	:	8448 SIEGEN LANE
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70810
Country	:	US
Telephone Number	:	225-767-8182
Fax Number	:	225-767-8757

Provider Business Practice Location Address
First Line	:	8448 SIEGEN LANE
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70810
Country	:	US
Telephone Number	:	225-767-8182
Fax Number	:	225-767-8757

Authorized Official
Title or Position	:	ACCOUNTS MANAGER
Name	:	JAMI PYLE I
Credential	:
Telephone Number	:	225-767-8182

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	04/07/2014

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