Provider Demographics
NPI:1134091697
Name:LEWIS, AUDREANA
Entity type:Individual
Prefix:
First Name:AUDREANA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 HELEN ST
Mailing Address - Street 2:
Mailing Address - City:LESAGE
Mailing Address - State:WV
Mailing Address - Zip Code:25537-2260
Mailing Address - Country:US
Mailing Address - Phone:304-840-3811
Mailing Address - Fax:
Practice Address - Street 1:120 MELROSE DR
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:WV
Practice Address - Zip Code:25086
Practice Address - Country:US
Practice Address - Phone:304-595-1155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV004748225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty