Provider Demographics
NPI:1477601722
Name:LEWIS, SUZANNE ELIZABETH (PT)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:ELIZABETH
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:SUZANNE
Other - Middle Name:ELIZABETH
Other - Last Name:MANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:216 VIA DIJON
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-4631
Mailing Address - Country:US
Mailing Address - Phone:929-949-1055
Mailing Address - Fax:
Practice Address - Street 1:1001 W 17TH ST
Practice Address - Street 2:SUITE R
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-4512
Practice Address - Country:US
Practice Address - Phone:949-929-1055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19955225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist