Provider Demographics
NPI:1952533986
Name:LEWIS, WILLIAM R (MSPT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 N YELLOWSTONE ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047-1943
Mailing Address - Country:US
Mailing Address - Phone:406-220-1837
Mailing Address - Fax:
Practice Address - Street 1:730 N YELLOWSTONE ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047-1943
Practice Address - Country:US
Practice Address - Phone:406-220-1837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-09
Last Update Date:2009-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1832225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist