Provider Demographics
NPI:1235114158
Name:ROTHMUND LEWIS, ASTRID EVA (PT)
Entity Type:Individual
Prefix:MRS
First Name:ASTRID
Middle Name:EVA
Last Name:ROTHMUND LEWIS
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 1:26 JEROME ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-6712
Mailing Address - Country:US
Mailing Address - Phone:617-290-2711
Mailing Address - Fax:781-646-1090
Practice Address - Street 1:26 JEROME ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-6712
Practice Address - Country:US
Practice Address - Phone:617-290-2711
Practice Address - Fax:781-646-1090
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15339225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY68606Medicare ID - Type UnspecifiedPHYSICAL THERAPY