Provider Demographics
NPI:1952718454
Name:LEWIS, TREVOR G
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:G
Last Name:LEWIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 WHITFORM FALLS RD
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-6361
Mailing Address - Country:US
Mailing Address - Phone:315-271-8974
Mailing Address - Fax:
Practice Address - Street 1:1003 WHITFORM FALLS RD
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-6361
Practice Address - Country:US
Practice Address - Phone:315-271-8974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-16
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305208328225100000X
MD24722225100000X
NY036429225100000X
TX1238759225100000X
OR60549225100000X
NC16088225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist