Provider Demographics
NPI:1194177485
Name:LEWIS, MATT (PHD, LAT, ATC, CSCS)
Entity type:Individual
Prefix:DR
First Name:MATT
Middle Name:
Last Name:LEWIS
Suffix:
Gender:M
Credentials:PHD, LAT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1442
Mailing Address - Country:US
Mailing Address - Phone:859-338-4479
Mailing Address - Fax:
Practice Address - Street 1:2300 VALLEY RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17104-1442
Practice Address - Country:US
Practice Address - Phone:859-338-4479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0055802255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer