Provider Demographics
NPI:1265490353
Name:LEWIS, SHELLEY L (PT)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:L
Last Name: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 1:5800 W 180TH ST
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:KS
Mailing Address - Zip Code:66085-8233
Mailing Address - Country:US
Mailing Address - Phone:913-269-3232
Mailing Address - Fax:
Practice Address - Street 1:5800 W 180TH ST
Practice Address - Street 2:
Practice Address - City:STILWELL
Practice Address - State:KS
Practice Address - Zip Code:66085-8233
Practice Address - Country:US
Practice Address - Phone:913-269-3232
Practice Address - Fax:913-413-0014
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS-001816225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSR23D208Medicare ID - Type Unspecified