Deron J Lewis, MPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501004840 Issued in MI

Practice address

4282 W Vienna Rd
Clio, MI 48420-9454

Phone

(810) 564-2400

Fax

(810) 564-9994

NPI assigned

May 3, 2006

Last updated

Jan 28, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580169600000",
    "number": "1770541393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4282 W VIENNA RD",
            "city": "CLIO",
            "state": "MI",
            "postal_code": "484209454",
            "telephone_number": "810-564-2400",
            "fax_number": "810-564-9994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4282 W VIENNA RD",
            "city": "CLIO",
            "state": "MI",
            "postal_code": "484209454",
            "telephone_number": "810-564-2400",
            "fax_number": "810-564-9994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEWIS",
        "first_name": "DERON",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "credential": "MPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-03",
        "last_updated": "2020-01-28",
        "certification_date": "2020-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501004840",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MI",
            "identifier": "30481",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Clio, MI
• Providers in Clio, MI by specialty
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.