Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 380 | AR |
NPI | 1073644696 |
---|---|
Provider Name | Dr. Donna Diane Lewis |
First Address | Little Rock, AR 72223-6500 |
Second Address | Little Rock, AR 72205-3535 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 08/07/2007 |