Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | ME119908 | FL |
NPI | 1013120294 |
---|---|
Provider Name | Aga Julia Lewelt |
First Address | Jacksonville, FL 32256-0532 |
Second Address | Orlando, FL 32827-7402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2007 |
Last Update Date | 25/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
012906500 | (05) | FL |