Provider Demographics
NPI:1114289634
Name:LEWIS HART, STEPHANIE LAUREN (PT, DPT, ATC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LAUREN
Last Name:LEWIS HART
Suffix:
Gender:F
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 GARSTON CT
Mailing Address - Street 2:
Mailing Address - City:STALLINGS
Mailing Address - State:NC
Mailing Address - Zip Code:28104-0053
Mailing Address - Country:US
Mailing Address - Phone:316-518-5095
Mailing Address - Fax:
Practice Address - Street 1:406 GARSTON CT
Practice Address - Street 2:
Practice Address - City:STALLINGS
Practice Address - State:NC
Practice Address - Zip Code:28104-0053
Practice Address - Country:US
Practice Address - Phone:316-518-5095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP14068225100000X
COPTL. 0011993225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist