Provider Demographics
NPI:1194016907
Name:LEWIS, KAREN RENEE (MA, PT)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:RENEE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MA, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1542 CANARSIE RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-5204
Mailing Address - Country:US
Mailing Address - Phone:718-241-0473
Mailing Address - Fax:
Practice Address - Street 1:1542 CANARSIE RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-5204
Practice Address - Country:US
Practice Address - Phone:718-241-0473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016926225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist