Provider Demographics
NPI:1669733358
Name:ACHATZ-LEWIS, GABRIELE E (CO, LO)
Entity type:Individual
Prefix:
First Name:GABRIELE
Middle Name:E
Last Name:ACHATZ-LEWIS
Suffix:
Gender:F
Credentials:CO, LO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 ASHVILLE AVE
Mailing Address - Street 2:STE 16
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-6678
Mailing Address - Country:US
Mailing Address - Phone:919-851-7385
Mailing Address - Fax:919-851-7387
Practice Address - Street 1:2534 EMPIRE DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6710
Practice Address - Country:US
Practice Address - Phone:336-397-2165
Practice Address - Fax:336-397-2167
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1003222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX294093401Medicaid