Provider Demographics
NPI:1164791679
Name:LEWIS, LINDSEY RAE (PTA)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:RAE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 VETERANS RD
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-8294
Mailing Address - Country:US
Mailing Address - Phone:660-543-5064
Mailing Address - Fax:660-543-5075
Practice Address - Street 1:1300 VETERANS RD
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-8294
Practice Address - Country:US
Practice Address - Phone:660-543-5064
Practice Address - Fax:660-543-5075
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009010247225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant