Provider Demographics
NPI:1013349042
Name:LEWIS, STEPHANIE WICKHAM (PT, DPT, OCS)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:WICKHAM
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5322 PRIMROSE LAKE CIR STE D
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3659
Mailing Address - Country:US
Mailing Address - Phone:813-606-5088
Mailing Address - Fax:
Practice Address - Street 1:5322 PRIMROSE LAKE CIR STE D
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3659
Practice Address - Country:US
Practice Address - Phone:813-606-5088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-01
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT284302251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic