Individual
CAROLYN JEANNE LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED.,P.T.
Contact information
Practice address
1102 ROSE HILL DR, CHARLOTTESVILLE, VA 22903-5128
(434) 979-8628
(434) 979-8536
Mailing address
470 FONTANA DR, CHARLOTTESVILLE, VA 22911-3527
(434) 979-8628
(434) 979-8536
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
2305004871
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4980671
—
VA
Enumeration date
12/08/2011
Last updated
12/08/2011
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