Provider Demographics
NPI:1740059195
Name:LEWIS, ERIN LYNN (PTA)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:LYNN
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 1:14902 E 41ST ST S
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-4251
Mailing Address - Country:US
Mailing Address - Phone:816-308-8721
Mailing Address - Fax:
Practice Address - Street 1:500 NW MURRAY RD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081-1455
Practice Address - Country:US
Practice Address - Phone:816-944-3280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-04170225200000X
MO2012025585225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant