Provider Demographics
NPI:1346545654
Name:LEWIS, SHELLY B
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:B
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1851 WALKERS WELL RD
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:VA
Mailing Address - Zip Code:24531-3388
Mailing Address - Country:US
Mailing Address - Phone:434-432-8464
Mailing Address - Fax:
Practice Address - Street 1:1851 WALKERS WELL RD
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:VA
Practice Address - Zip Code:24531-3388
Practice Address - Country:US
Practice Address - Phone:434-432-8464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant