Provider Demographics
NPI:1598071839
Name:LEWIS-WILSON, NAIKIA MICHELLE (PT)
Entity Type:Individual
Prefix:
First Name:NAIKIA
Middle Name:MICHELLE
Last Name:LEWIS-WILSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 S PICKETT ST
Mailing Address - Street 2:201
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-4742
Mailing Address - Country:US
Mailing Address - Phone:240-432-0109
Mailing Address - Fax:
Practice Address - Street 1:287 S PICKETT ST
Practice Address - Street 2:201
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-4742
Practice Address - Country:US
Practice Address - Phone:240-432-0109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC2750225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist