Individual
MR. JACOB WALTON LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAT, ATC, CKTP
Contact information
Practice address
5735 COLLEGE PKWY, EIGHT MILE, AL 36613-2842
(251) 442-2561
Mailing address
5735 COLLEGE PARKWAY, EIGHT MILE, AL 36613
(251) 442-2561
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1523
AL
Other
Enumeration date
05/12/2022
Last updated
05/12/2022
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