Provider Demographics
NPI:1720335557
Name:LEWIS, JOYCE (PTA)
Entity Type:Individual
Prefix:MS
First Name:JOYCE
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7817 CATHERINE AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-1648
Mailing Address - Country:US
Mailing Address - Phone:443-306-3142
Mailing Address - Fax:
Practice Address - Street 1:17000 SCIENCE DR
Practice Address - Street 2:SUITE 104
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-4420
Practice Address - Country:US
Practice Address - Phone:301-860-0237
Practice Address - Fax:301-860-0076
Is Sole Proprietor?:No
Enumeration Date:2012-08-10
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA3818225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant