MEDICARE: MS. KERRI K LEWIS

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	PTA00568	RI
2	163W00000X	Registered Nurse	RN550553	OH

General Provider Information

NPI Number	:	1396270187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KERRI K LEWIS

Provider Business Mailing Address
First Line	:	130 SHELFORD WAY
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45440-3658
Country	:	US
Telephone Number	:	401-864-0032
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 SHELFORD WAY
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45440-3658
Country	:	US
Telephone Number	:	401-864-0032
Fax Number	:

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

Provider Enumeration Date	:	04/29/2017
Last Update Date	:	02/20/2026

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