Provider Demographics
NPI:1639305261
Name:ROBERTS, LEWIS WESLEY (CRT)
Entity Type:Individual
Prefix:
First Name:LEWIS
Middle Name:WESLEY
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2709 ROPER DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-2410
Mailing Address - Country:US
Mailing Address - Phone:903-718-0863
Mailing Address - Fax:903-532-1401
Practice Address - Street 1:8001 S US HWY 75
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-5707
Practice Address - Country:US
Practice Address - Phone:903-718-0863
Practice Address - Fax:903-532-1401
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX595302278H0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX59530OtherRESPIRATORY CARE PRACTITIONER