Provider Demographics
NPI:1063787364
Name:LEWIS, JENNIFER LYN (ATC, LAT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYN
Other - Last Name:ARTIOLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC, LAT
Mailing Address - Street 1:1701 MILITARY TRL STE 145A
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-6330
Mailing Address - Country:US
Mailing Address - Phone:561-781-0989
Mailing Address - Fax:
Practice Address - Street 1:1701 MILITARY TRL STE 145A
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-6330
Practice Address - Country:US
Practice Address - Phone:561-781-0989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006018514174H00000X
FLAL57632255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No174H00000XOther Service ProvidersHealth Educator