Provider Demographics
NPI:1659506160
Name:LEWIS, TAMARA (PT)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:LEWIS
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 1:827 MAGNOLIA BLVD
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77355-8602
Mailing Address - Country:US
Mailing Address - Phone:281-277-0751
Mailing Address - Fax:281-277-0761
Practice Address - Street 1:827 MAGNOLIA BLVD
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77355-8602
Practice Address - Country:US
Practice Address - Phone:281-277-0751
Practice Address - Fax:281-277-0761
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1185463225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist