Provider Demographics
NPI:1144497397
Name:LEWIS, DALLAS JAMES III (PT DPT MPT OCS)
Entity type:Individual
Prefix:DR
First Name:DALLAS
Middle Name:JAMES
Last Name:LEWIS
Suffix:III
Gender:M
Credentials:PT DPT MPT OCS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1061 HARMON AVE
Mailing Address - Street 2:SUITE 1D03
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314-5641
Mailing Address - Country:US
Mailing Address - Phone:912-315-2416
Mailing Address - Fax:
Practice Address - Street 1:1061 HARMON AVE
Practice Address - Street 2:SUITE 1D03
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314-5641
Practice Address - Country:US
Practice Address - Phone:912-315-2416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20061225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist