Provider Demographics
NPI:1013038603
Name:LEWIS, JO A (CTRS)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:A
Last Name:LEWIS
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 CIMARRON CT
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2542
Mailing Address - Country:US
Mailing Address - Phone:863-646-2656
Mailing Address - Fax:
Practice Address - Street 1:1350 SLEEPY HILL RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33810-3800
Practice Address - Country:US
Practice Address - Phone:863-858-4402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist