Provider Demographics
NPI:1396356754
Name:LEWIS, LINDSAY KATHRYN (PTA)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:KATHRYN
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 1:641 PLAINFIELD PIKE
Mailing Address - Street 2:
Mailing Address - City:MOOSUP
Mailing Address - State:CT
Mailing Address - Zip Code:06354-2022
Mailing Address - Country:US
Mailing Address - Phone:978-239-8273
Mailing Address - Fax:
Practice Address - Street 1:20 BABCOCK AVE
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:CT
Practice Address - Zip Code:06374-1226
Practice Address - Country:US
Practice Address - Phone:860-564-3387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2102225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant