MEDICARE: JACKLYN LEWIS PT, DPT

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	05013037A	IN

General Provider Information

NPI Number	:	1740131697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACKLYN LEWIS PT, DPT

Provider Business Mailing Address
First Line	:	PO BOX 637764
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-7764
Country	:	US
Telephone Number	:	317-880-3939
Fax Number	:	317-880-0343

Provider Business Practice Location Address
First Line	:	6002 E 38TH ST STE 1500
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46226-5620
Country	:	US
Telephone Number	:	317-880-0280
Fax Number	:

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

Provider Enumeration Date	:	02/06/2026
Last Update Date	:	03/09/2026

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