MEDICARE: MICHAEL JOSEPH LEWKOVICH PTA

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	PTA27950	FL

General Provider Information

NPI Number	:	1922512615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL JOSEPH LEWKOVICH PTA

Provider Business Mailing Address
First Line	:	2032 6TH CT S
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-5610
Country	:	US
Telephone Number	:	561-674-6348
Fax Number	:

Provider Business Practice Location Address
First Line	:	3319 S STATE ROAD 7 STE 310
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33449-8147
Country	:	US
Telephone Number	:	561-795-5870
Fax Number	:

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

Provider Enumeration Date	:	11/17/2017
Last Update Date	:	11/17/2017

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