Provider Demographics
NPI:1053719716
Name:LEWIS, TIMOTHY D (DPT)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:D
Last Name:LEWIS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:SAILBOAT
Other - Middle Name:
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:41 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06854-2702
Mailing Address - Country:US
Mailing Address - Phone:203-857-1227
Mailing Address - Fax:
Practice Address - Street 1:41 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06854-2702
Practice Address - Country:US
Practice Address - Phone:203-857-1227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-11
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT137452251X0800X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist