Provider Demographics
NPI:1427598986
Name:LEWIS, LORI ANN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANN
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 1:330 SOUTHWEST AVE
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-2235
Mailing Address - Country:US
Mailing Address - Phone:234-678-6198
Mailing Address - Fax:234-678-6742
Practice Address - Street 1:330 SOUTHWEST AVE
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-2235
Practice Address - Country:US
Practice Address - Phone:234-678-6198
Practice Address - Fax:234-678-6742
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-03
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA011127225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant