Provider Demographics
NPI:1427011436
Name:LEWIS, JONATHAN SCOTT (PT)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:SCOTT
Last Name:LEWIS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 PARK PL STE 2
Mailing Address - Street 2:
Mailing Address - City:SHIPPENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17257-9806
Mailing Address - Country:US
Mailing Address - Phone:717-477-8030
Mailing Address - Fax:717-477-8040
Practice Address - Street 1:20 PARK PL STE 2
Practice Address - Street 2:
Practice Address - City:SHIPPENSBURG
Practice Address - State:PA
Practice Address - Zip Code:17257-9806
Practice Address - Country:US
Practice Address - Phone:717-477-8030
Practice Address - Fax:717-477-8040
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT006451L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0013902500006Medicaid
PA5819531OtherAETNA
PA033040OtherBLUE SHIELD PIN
PA0013902500Medicaid
PA2119174OtherAETNA
MDT7090001OtherCAREFIRST NATIONAL PIN
PA01425101OtherCAPITAL BC PIN
PA0659812000OtherPERSONAL CHOICE
MD54238503OtherCAREFIRST PIN