Provider Demographics
NPI:1609568450
Name:LEWIS, DAMEIAN
Entity Type:Individual
Prefix:
First Name:DAMEIAN
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 OLD SPANISH TRAIL HWY LOT 4
Mailing Address - Street 2:
Mailing Address - City:BROUSSARD
Mailing Address - State:LA
Mailing Address - Zip Code:70518-8128
Mailing Address - Country:US
Mailing Address - Phone:337-321-0010
Mailing Address - Fax:
Practice Address - Street 1:1431 OLD SPANISH TRAIL HWY LOT 4
Practice Address - Street 2:
Practice Address - City:BROUSSARD
Practice Address - State:LA
Practice Address - Zip Code:70518-8128
Practice Address - Country:US
Practice Address - Phone:337-321-0010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty