Provider Demographics
NPI:1386828945
Name:LEWIS, PAULETTE LORENE (MPT, DPT)
Entity type:Individual
Prefix:DR
First Name:PAULETTE
Middle Name:LORENE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MPT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 HIGHBRANCH WAY
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-6217
Mailing Address - Country:US
Mailing Address - Phone:954-303-4670
Mailing Address - Fax:
Practice Address - Street 1:100 MILLBROOK VILLAGE DR STE C
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-3603
Practice Address - Country:US
Practice Address - Phone:678-545-6666
Practice Address - Fax:770-629-7978
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008946225100000X
FLPT22023225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist