MEDICARE: COLE J LEWANDOWSKI 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	14676-24	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14676-24	OTHER	WI	STATE OF WISCONSIN

General Provider Information

NPI Number	:	1851950778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLE J LEWANDOWSKI PT, DPT

Provider Business Mailing Address
First Line	:	600 52ND ST STE 240
Second Line	:
City	:	KENOSHA
State	:	WI
Zip	:	53140-3423
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3620 57TH AVE STE 400
Second Line	:
City	:	KENOSHA
State	:	WI
Zip	:	53144-4925
Country	:	US
Telephone Number	:	262-925-5250
Fax Number	:

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

Provider Enumeration Date	:	06/13/2019
Last Update Date	:	06/13/2019

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