Provider Demographics
NPI:1841706363
Name:LEWIS, GARY LYNN JR (PTA)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:LYNN
Last Name:LEWIS
Suffix:JR
Gender:M
Credentials:PTA
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Mailing Address - Street 1:5451 INDEPENDENCE PKWY APT 2907
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-5441
Mailing Address - Country:US
Mailing Address - Phone:903-805-4333
Mailing Address - Fax:
Practice Address - Street 1:9215 WHITE ROCK TRL
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-2593
Practice Address - Country:US
Practice Address - Phone:214-221-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2127103225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant