Provider Demographics
NPI:1407890577
Name:LEWIS, ERIN R (MS, PT)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:R
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 933
Mailing Address - Street 2:
Mailing Address - City:GREENBRIER
Mailing Address - State:AR
Mailing Address - Zip Code:72058
Mailing Address - Country:US
Mailing Address - Phone:501-581-6045
Mailing Address - Fax:
Practice Address - Street 1:4 GROVE STREET
Practice Address - Street 2:
Practice Address - City:MAYFLOWER
Practice Address - State:AR
Practice Address - Zip Code:72106
Practice Address - Country:US
Practice Address - Phone:501-470-0387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2020-01-02
Deactivation Date:2017-08-22
Deactivation Code:
Reactivation Date:2019-12-18
Provider Licenses
StateLicense IDTaxonomies
AR24602251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5W494OtherAR BLUECROSS BLUESHIELD
AR142216721Medicaid