MEDICARE: MS. KIMBERLY ANN LEWIS 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	2251P0200X	Pediatric Physical Therapist	002323	GA

General Provider Information

NPI Number	:	1942362645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIMBERLY ANN LEWIS PT

Provider Business Mailing Address
First Line	:	2818 TANNER LAKE TRL NW
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30064-1200
Country	:	US
Telephone Number	:	770-427-4045
Fax Number	:	770-424-7195

Provider Business Practice Location Address
First Line	:	2818 TANNER LAKE TRL NW
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30064-1200
Country	:	US
Telephone Number	:	770-427-4045
Fax Number	:	770-424-7195

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

Provider Enumeration Date	:	12/16/2006
Last Update Date	:	07/08/2007

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Directions to “ MS. KIMBERLY ANN LEWIS PT” Practice Location

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