Basic Information
| Provider Information | |||||||||
| NPI: | 1245605484 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | KATHERINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1419 ADDISON PL | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | POOLER | ||||||||
| State: | GA | ||||||||
| PostalCode: | 313229471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9044494666 | ||||||||
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| Practice Location | |||||||||
| Address1: | 201 BUSINESS PARK DR | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | RINCON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 313265583 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8778261509 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2015 | ||||||||
| LastUpdateDate: | 12/13/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT012196 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.