Provider Demographics
NPI:1346907821
Name:LEWIS, AMY (PTA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13527 HARRISGLENN DR APT 3319
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-6849
Mailing Address - Country:US
Mailing Address - Phone:512-731-7419
Mailing Address - Fax:
Practice Address - Street 1:412 N DALTON ST
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TX
Practice Address - Zip Code:76511-4332
Practice Address - Country:US
Practice Address - Phone:254-527-3371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2112940225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant