Provider Demographics
NPI:1184244576
Name:LEWIS, ALYSSA (LAT, ATC)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 LAKEVIEW POINT AVE
Mailing Address - Street 2:
Mailing Address - City:BRANCHVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07826-6002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18 LAKEVIEW POINT AVE
Practice Address - Street 2:
Practice Address - City:BRANCHVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07826-6002
Practice Address - Country:US
Practice Address - Phone:862-354-0811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-26
Last Update Date:2020-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT002179002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer