Provider Demographics
NPI:1164679841
Name:AREVALO, LEWELYN (PT)
Entity Type:Individual
Prefix:
First Name:LEWELYN
Middle Name:
Last Name:AREVALO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52654 IRONWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1123
Mailing Address - Country:US
Mailing Address - Phone:574-277-8710
Mailing Address - Fax:
Practice Address - Street 1:52654 IRONWOOD RD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1123
Practice Address - Country:US
Practice Address - Phone:574-277-8710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-25
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008053A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist