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Individual

CORY I LEWIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DPT

Contact information

Practice address
740 MCKINLEY AVE, KELLOGG, ID 83837-2523
(208) 457-9125
Mailing address
740 MCKINLEY AVE, KELLOGG, ID 83837-2523
(208) 457-9125

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT1971
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010159647
REGENCE
ID
01
T6319
BLUE CROSS
ID
Enumeration date
06/15/2006
Last updated
01/21/2008
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