Provider Demographics
NPI:1306288527
Name:LEWIS, THOMAS BRUCE (PTA)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:BRUCE
Last Name:LEWIS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3385 MAPLE TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-3705
Mailing Address - Country:US
Mailing Address - Phone:770-271-3472
Mailing Address - Fax:
Practice Address - Street 1:400 DAWSON COMMONS CIR
Practice Address - Street 2:SUITE 430
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-6269
Practice Address - Country:US
Practice Address - Phone:706-268-7905
Practice Address - Fax:706-265-8788
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA003133225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant