Provider Demographics
NPI:1760691638
Name:LEWANDOWSKI, CHERYLE RAE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:CHERYLE
Middle Name:RAE
Last Name:LEWANDOWSKI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 VAN KLEY DR
Mailing Address - Street 2:
Mailing Address - City:WHEATFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46392-9291
Mailing Address - Country:US
Mailing Address - Phone:219-956-4904
Mailing Address - Fax:
Practice Address - Street 1:10352 N 600 E
Practice Address - Street 2:
Practice Address - City:DEMOTTE
Practice Address - State:IN
Practice Address - Zip Code:46310
Practice Address - Country:US
Practice Address - Phone:219-345-5211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06002526A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant