Provider Demographics
NPI:1427776871
Name:LEWIS, JESSICA N (PT, DPT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:N
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 949
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30162-0949
Mailing Address - Country:US
Mailing Address - Phone:404-367-2080
Mailing Address - Fax:770-495-3493
Practice Address - Street 1:1180 SATELLITE BLVD NW STE 100
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-4637
Practice Address - Country:US
Practice Address - Phone:404-367-2080
Practice Address - Fax:770-495-3493
Is Sole Proprietor?:No
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT016139225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist