MEDICARE: GEOFFREY LEW 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	PT29604	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT29604	OTHER	CA	PHYSICAL THERAPY LICENSE

General Provider Information

NPI Number	:	1437163086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEOFFREY LEW PT

Provider Business Mailing Address
First Line	:	PO BOX 491689
Second Line	:
City	:	REDDING
State	:	CA
Zip	:	96049-1689
Country	:	US
Telephone Number	:	650-697-2376
Fax Number	:	650-697-2374

Provider Business Practice Location Address
First Line	:	39 EL CAMINO REAL
Second Line	:
City	:	MILLBRAE
State	:	CA
Zip	:	94030-2603
Country	:	US
Telephone Number	:	650-697-2376
Fax Number	:	650-697-2374

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

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	02/25/2011

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Directions to “ GEOFFREY LEW PT” Practice Location

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