Provider Demographics
NPI:1326804345
Name:LEWIS, WILLIAM L
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:L
Last Name:LEWIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 FORT PEMBERTON CT
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22026-2570
Mailing Address - Country:US
Mailing Address - Phone:703-517-2546
Mailing Address - Fax:
Practice Address - Street 1:2701 NEABSCO COMMON PL STE 118
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-4189
Practice Address - Country:US
Practice Address - Phone:703-343-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019016559225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist