Provider Demographics
NPI:1790734267
Name:LEWIS, STEVEN R (PT)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:R
Last Name:LEWIS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-1728
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:624 MAYSVILLE RD
Practice Address - Street 2:SUITE C
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-9767
Practice Address - Country:US
Practice Address - Phone:859-499-4351
Practice Address - Fax:859-499-5321
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY003265225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY8700143400Medicaid
KY8700143400Medicaid