Provider Demographics
NPI:1659650802
Name:LEWIS, VIRGINIA (DPT)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:558 1ST SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:WOODVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39669-3777
Mailing Address - Country:US
Mailing Address - Phone:601-888-7944
Mailing Address - Fax:601-888-4767
Practice Address - Street 1:558 1ST SOUTH ST
Practice Address - Street 2:
Practice Address - City:WOODVILLE
Practice Address - State:MS
Practice Address - Zip Code:39669-3777
Practice Address - Country:US
Practice Address - Phone:601-888-7944
Practice Address - Fax:601-888-4767
Is Sole Proprietor?:No
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4931225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist