Provider Demographics
NPI:1033433289
Name:LEWIS, SCOTT ALLEN
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:ALLEN
Last Name:LEWIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 17TH ST NW STE 2D
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-3486
Mailing Address - Country:US
Mailing Address - Phone:507-433-8139
Mailing Address - Fax:507-481-5665
Practice Address - Street 1:1700 17TH ST NW STE 2D
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-3486
Practice Address - Country:US
Practice Address - Phone:507-433-8139
Practice Address - Fax:507-481-5665
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-17
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5221225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist