Provider Demographics
NPI:1356095715
Name:JOVIAL LEWIS PEDIATRIC PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:JOVIAL LEWIS PEDIATRIC PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST-PEDIATRIC
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOVIAL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-427-5585
Mailing Address - Street 1:5301 SKILLMAN AVE APT 3R
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-4121
Mailing Address - Country:US
Mailing Address - Phone:718-427-5585
Mailing Address - Fax:718-507-4401
Practice Address - Street 1:5615 251ST ST
Practice Address - Street 2:
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11362-2117
Practice Address - Country:US
Practice Address - Phone:718-427-5585
Practice Address - Fax:718-507-4401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty