Provider Demographics
NPI:1336889013
Name:LEWIS, JEWEL
Entity type:Individual
Prefix:
First Name:JEWEL
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 WALMART SUPERCENTER
Mailing Address - Street 2:
Mailing Address - City:SILER CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27344-6756
Mailing Address - Country:US
Mailing Address - Phone:919-799-2226
Mailing Address - Fax:919-799-2216
Practice Address - Street 1:10102 S MAIN ST STE S
Practice Address - Street 2:
Practice Address - City:ARCHDALE
Practice Address - State:NC
Practice Address - Zip Code:27263-3183
Practice Address - Country:US
Practice Address - Phone:336-307-3015
Practice Address - Fax:336-307-3004
Is Sole Proprietor?:No
Enumeration Date:2022-03-30
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225100000X
NC21094225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist