Provider Demographics
NPI:1932446002
Name:LEWIS, PATRICK D (CTRS)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:D
Last Name:LEWIS
Suffix:
Gender:M
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 YUCCA CT
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-3540
Mailing Address - Country:US
Mailing Address - Phone:281-451-8042
Mailing Address - Fax:832-637-7446
Practice Address - Street 1:4111 YUCCA CT
Practice Address - Street 2:
Practice Address - City:MANVEL
Practice Address - State:TX
Practice Address - Zip Code:77578-3540
Practice Address - Country:US
Practice Address - Phone:281-451-8042
Practice Address - Fax:832-637-7446
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
41348225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist