Provider Demographics
NPI:1174962252
Name:LEWIS PELVIC FLOOR THERAPY PLLC
Entity type:Organization
Organization Name:LEWIS PELVIC FLOOR THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MS
Authorized Official - Phone:434-960-4434
Mailing Address - Street 1:3040 BERKMAR DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-1593
Mailing Address - Country:US
Mailing Address - Phone:434-960-4434
Mailing Address - Fax:434-260-8681
Practice Address - Street 1:3040 BERKMAR DR
Practice Address - Street 2:SUITE A
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1593
Practice Address - Country:US
Practice Address - Phone:434-960-4434
Practice Address - Fax:434-260-8681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-21
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202475225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty