Provider Demographics
NPI:1427787969
Name:LEWIS, MAYA (ATC)
Entity type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 FLETCHER AVE APT 63
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68504-1185
Mailing Address - Country:US
Mailing Address - Phone:531-205-8943
Mailing Address - Fax:
Practice Address - Street 1:841 N 14TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68588-1282
Practice Address - Country:US
Practice Address - Phone:402-472-3438
Practice Address - Fax:402-472-8080
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11122255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer