Provider Demographics
NPI:1922845031
Name:LEWIS, ALEXIS FAITH (PTA)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:FAITH
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 MONTCALM ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04937-1138
Mailing Address - Country:US
Mailing Address - Phone:207-314-7776
Mailing Address - Fax:
Practice Address - Street 1:95 SKOWHEGAN RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:ME
Practice Address - Zip Code:04937-3479
Practice Address - Country:US
Practice Address - Phone:207-453-1330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA6869225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant