Provider Demographics
NPI:1467697664
Name:LEWIS, FE'NEDA O (MPT)
Entity Type:Individual
Prefix:MS
First Name:FE'NEDA
Middle Name:O
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5495 PEAR TREE DR
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48519-1574
Mailing Address - Country:US
Mailing Address - Phone:810-516-6734
Mailing Address - Fax:
Practice Address - Street 1:G-2241 S. LINDEN RD
Practice Address - Street 2:SUITE A
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3458
Practice Address - Country:US
Practice Address - Phone:810-732-8400
Practice Address - Fax:810-732-4075
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013976225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist