Provider Demographics
NPI:1215014881
Name:LEWIS, REED LAWRENCE (MS,PT)
Entity Type:Individual
Prefix:
First Name:REED
Middle Name:LAWRENCE
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MS,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:699 N CLAREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-7305
Mailing Address - Country:US
Mailing Address - Phone:559-324-0448
Mailing Address - Fax:
Practice Address - Street 1:6049 N 1ST ST
Practice Address - Street 2:SUITE #101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5449
Practice Address - Country:US
Practice Address - Phone:559-432-0524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 22014225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT220140Medicare PIN