Provider Demographics
NPI:1659546398
Name:LEWIS, COURTNEY N (BS)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:N
Last Name:LEWIS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 NORTHRIDE TRL
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813
Mailing Address - Country:US
Mailing Address - Phone:863-450-4274
Mailing Address - Fax:863-450-4274
Practice Address - Street 1:529 NORTHRIDE TRL
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-1561
Practice Address - Country:US
Practice Address - Phone:863-450-4274
Practice Address - Fax:863-450-4274
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist