Provider Demographics
NPI:1659618924
Name:LEWIS, DELISA NICHELLE (PT)
Entity Type:Individual
Prefix:
First Name:DELISA
Middle Name:NICHELLE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DELISA
Other - Middle Name:NICHELLE
Other - Last Name:RIDEOUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8302 ESPRESSO DR
Mailing Address - Street 2:100
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-5687
Mailing Address - Country:US
Mailing Address - Phone:661-377-1700
Mailing Address - Fax:661-616-9199
Practice Address - Street 1:7737 MEANY AVE
Practice Address - Street 2:B5
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-5266
Practice Address - Country:US
Practice Address - Phone:661-377-1700
Practice Address - Fax:661-616-9199
Is Sole Proprietor?:No
Enumeration Date:2013-01-07
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39596225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist