Provider Demographics
NPI:1639636160
Name:GRAVES, LEWIS WINSTON JR (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:WINSTON
Last Name:GRAVES
Suffix:JR
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N MONROE ST APT 728
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-2374
Mailing Address - Country:US
Mailing Address - Phone:540-840-2401
Mailing Address - Fax:
Practice Address - Street 1:801 N MONROE ST APT 728
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22201-2374
Practice Address - Country:US
Practice Address - Phone:540-840-2401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-20
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC45-4005110208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation