Provider Demographics
NPI:1720161730
Name:LEWIS, JOHN A (DPT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:A
Last Name:LEWIS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 W CHANDLER BLVD STE A-4
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-4908
Mailing Address - Country:US
Mailing Address - Phone:602-430-6286
Mailing Address - Fax:602-957-2017
Practice Address - Street 1:900 W CHANDLER BLVD STE A-4
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-4908
Practice Address - Country:US
Practice Address - Phone:602-430-6286
Practice Address - Fax:602-957-2017
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPT6733225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ112825Medicare PIN