Provider Demographics
NPI:1043534423
Name:LEWIS, THOMAS ALAN
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ALAN
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 1:1000 BRAZOS ST
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:TX
Mailing Address - Zip Code:76450-3944
Mailing Address - Country:US
Mailing Address - Phone:940-549-4277
Mailing Address - Fax:940-549-4031
Practice Address - Street 1:1000 BRAZOS ST
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:TX
Practice Address - Zip Code:76450-3944
Practice Address - Country:US
Practice Address - Phone:940-549-4277
Practice Address - Fax:940-549-4031
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT07792255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer