Provider Demographics
NPI:1700296282
Name:LEWIS, KATHLEEN EVA (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:EVA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 CORONADO AVE.
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44504-1307
Mailing Address - Country:US
Mailing Address - Phone:330-747-0822
Mailing Address - Fax:
Practice Address - Street 1:1824 CORONADO AVE.
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1307
Practice Address - Country:US
Practice Address - Phone:330-747-0822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-06
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH52102251P0200X
OHPT005210225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1700296282Medicaid