Provider Demographics
NPI:1184827222
Name:LEW, SUSAN E (PT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:LEW
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 1:6417 CHALFONT CIR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-4195
Mailing Address - Country:US
Mailing Address - Phone:910-509-3196
Mailing Address - Fax:910-256-8560
Practice Address - Street 1:530 CAUSEWAY DR
Practice Address - Street 2:STE. B-3
Practice Address - City:WRIGHTSVILLE BEACH
Practice Address - State:NC
Practice Address - Zip Code:28480-1959
Practice Address - Country:US
Practice Address - Phone:910-509-2810
Practice Address - Fax:910-256-8560
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8531225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2503966Medicare ID - Type Unspecified