Provider Demographics
NPI:1164609004
Name:LEWIS, KIM M (MPT)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:M
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 BEISER BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-7793
Mailing Address - Country:US
Mailing Address - Phone:302-736-0994
Mailing Address - Fax:302-736-5529
Practice Address - Street 1:230 BEISER BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-7793
Practice Address - Country:US
Practice Address - Phone:302-736-0994
Practice Address - Fax:302-736-5529
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-00011882251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic