Provider Demographics
NPI:1881168078
Name:LEWIS, JESSIE LYNN (PHYSICAL THERAPY)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:LYNN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PHYSICAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3315 E MICHIGAN AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-4649
Mailing Address - Country:US
Mailing Address - Phone:517-364-8600
Mailing Address - Fax:
Practice Address - Street 1:3315 E MICHIGAN AVE STE 4
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-4649
Practice Address - Country:US
Practice Address - Phone:517-364-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic