Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | A3273 | NC |
NPI | 1013305093 |
---|---|
Provider Name | Jonna Lewis |
First Address | Valdese, NC 28690-9479 |
Second Address | Valdese, NC 28690-9479 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2014 |
Last Update Date | 10/11/2015 |