Provider Demographics
NPI:1104408558
Name:LEWIS OUTPATIENT PHYSICAL THERAPY SERVICES
Entity type:Organization
Organization Name:LEWIS OUTPATIENT PHYSICAL THERAPY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:507-433-8139
Mailing Address - Street 1:1700 17TH ST NW STE 2D
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-3486
Mailing Address - Country:US
Mailing Address - Phone:507-433-8139
Mailing Address - Fax:507-433-6184
Practice Address - Street 1:1700 17TH ST NW STE 2D
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-3486
Practice Address - Country:US
Practice Address - Phone:507-433-8139
Practice Address - Fax:507-433-6184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-26
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty