Provider Demographics
NPI:1982764635
Name:LEWIS, JENNIFER N (MSPT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:N
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2445 ARMY NAVY DRIVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-2994
Mailing Address - Country:US
Mailing Address - Phone:703-892-6500
Mailing Address - Fax:703-892-1550
Practice Address - Street 1:2445 ARMY NAVY DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22206-2905
Practice Address - Country:US
Practice Address - Phone:703-892-6500
Practice Address - Fax:703-892-1550
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202574225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist