Provider Demographics
NPI:1427172923
Name:LEWIS, IRENE
Entity type:Individual
Prefix:
First Name:IRENE
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 1:4017 ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:IL
Mailing Address - Zip Code:60534
Mailing Address - Country:US
Mailing Address - Phone:708-214-9141
Mailing Address - Fax:
Practice Address - Street 1:3071 WOLF RD
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-5622
Practice Address - Country:US
Practice Address - Phone:708-562-0999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070004238225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL131415300OtherUS DEPARTMENT OF LABOR
IL1617848OtherBLUE CROSS BLUE SHIELD
IL131415300OtherUS DEPARTMENT OF LABOR