Provider Demographics
NPI:1376697805
Name:LEWIS, DAREN KEITH (MPT)
Entity Type:Individual
Prefix:MR
First Name:DAREN
Middle Name:KEITH
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20607 NE 6TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-2421
Mailing Address - Country:US
Mailing Address - Phone:954-600-3568
Mailing Address - Fax:305-651-3361
Practice Address - Street 1:20607 NE 6TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-2421
Practice Address - Country:US
Practice Address - Phone:954-600-3568
Practice Address - Fax:305-651-3361
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19936225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist