Healthcare Provider Details

I. General information

NPI: 1932023462
Provider Name (Legal Business Name): PIM JACOB ANTHONY LEWIS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7311 GREENHAVEN DR STE 200
SACRAMENTO CA
95831-3594
US

IV. Provider business mailing address

9130 NOLAN ST APT 1038
ELK GROVE CA
95758-7543
US

V. Phone/Fax

Practice location:
  • Phone: 916-570-7900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number310686
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: