Provider Demographics
NPI:1699806224
Name:LEWIS, TODD WESLEY
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:WESLEY
Last Name:LEWIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:838 N MARENGO AVE
Mailing Address - Street 2:#2
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-3108
Mailing Address - Country:US
Mailing Address - Phone:626-396-9727
Mailing Address - Fax:
Practice Address - Street 1:14530 HAMLIN ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-1607
Practice Address - Country:US
Practice Address - Phone:818-373-4993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner