Individual
MRS. STEPHANIE LYNN LEWELLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1603 CHASE RD, LOGANSPORT, IN 46947-1538
(574) 737-7404
Mailing address
2898 S LOCKPORT RD, LOGANSPORT, IN 46947-7290
(574) 652-2249
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05007388A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000201263
ANTHEM
IN
Enumeration date
04/13/2007
Last updated
07/08/2007
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