Healthcare Provider Details

I. General information

NPI: 1235195066
Provider Name (Legal Business Name): JUDITH LEE LEWIS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7211 29TH AVE NE
SEATTLE WA
98115-5851
US

IV. Provider business mailing address

7211 29TH AVE NE
SEATTLE WA
98115-5851
US

V. Phone/Fax

Practice location:
  • Phone: 206-258-4580
  • Fax: 206-258-4581
Mailing address:
  • Phone: 206-258-4580
  • Fax: 206-258-4581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberOP 00001398
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: