Provider Demographics
NPI:1790702272
Name:LEWIS, LARRY WAYNE JR (PT)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:WAYNE
Last Name:LEWIS
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:5383 ANTLER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:GRANITE FALLS
Mailing Address - State:NC
Mailing Address - Zip Code:28630-8813
Mailing Address - Country:US
Mailing Address - Phone:828-244-1073
Mailing Address - Fax:828-313-0373
Practice Address - Street 1:322 NUWAY CIR
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-3656
Practice Address - Country:US
Practice Address - Phone:828-758-7326
Practice Address - Fax:828-757-0938
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2016-09-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC7268225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC07916OtherBLUE CROSS BLUE SHIELD
NC07916OtherBLUE CROSS BLUE SHIELD