Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 40QA01168900 | NJ |
N | 2251P0200X | Physical Therapist - Pediatrics | 40QA01168900 | NJ |
NPI | 1023220035 |
---|---|
Provider Name | Jocelyn Lyschell Lewis |
First Address | West Berlin, NJ 08091 |
Second Address | Seven Fields, PA 16046-7861 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 28/01/2010 |