Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 160.007139 | IL |
NPI | 1013451442 |
---|---|
Provider Name | Cynthia Lewis |
First Address | New Lenox, IL 60451-1951 |
Second Address | New Lenox, IL 60451-1951 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2016 |
Last Update Date | 03/12/2016 |