Healthcare Provider Details

I. General information

NPI: 1457419939
Provider Name (Legal Business Name): JOEL EMERSON LEWIS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2748 MILTON WAY STE 207
MILTON WA
98354-9379
US

IV. Provider business mailing address

2748 MILTON WAY STE 207
MILTON WA
98354-9379
US

V. Phone/Fax

Practice location:
  • Phone: 253-925-5623
  • Fax: 253-661-9771
Mailing address:
  • Phone: 253-925-5623
  • Fax: 253-661-9771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT00005786
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: