Provider Demographics
NPI:1861453045
Name:LEWIS, JOANNA B (MSPT)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:B
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:B
Other - Last Name:JENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:8907 KARVER LANE
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003
Mailing Address - Country:US
Mailing Address - Phone:703-426-1934
Mailing Address - Fax:703-426-1934
Practice Address - Street 1:8907 KARVER LN
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-4116
Practice Address - Country:US
Practice Address - Phone:703-426-1934
Practice Address - Fax:703-426-1934
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204063225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist