Provider Demographics
NPI:1982826871
Name:LEWIS, STEPHANIE ANN (ATC)
Entity Type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:ANN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1994 CAMP RDG
Mailing Address - Street 2:
Mailing Address - City:TWIN LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49457-8970
Mailing Address - Country:US
Mailing Address - Phone:231-720-5263
Mailing Address - Fax:
Practice Address - Street 1:20565 OLD IRONSIDES DR
Practice Address - Street 2:
Practice Address - City:FORT BLISS
Practice Address - State:TX
Practice Address - Zip Code:79918-8068
Practice Address - Country:US
Practice Address - Phone:915-744-2166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer