MEDICARE: JACOB JOSEPH LEWIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	A-1381	NV
2	225200000X	Physical Therapy Assistant	53800	CA

General Provider Information

NPI Number	:	1639972797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB JOSEPH LEWIS

Provider Business Mailing Address
First Line	:	2260 W EL CAMINO REAL APT 1321
Second Line	:
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94040-6247
Country	:	US
Telephone Number	:	775-722-8588
Fax Number	:

Provider Business Practice Location Address
First Line	:	2260 W EL CAMINO REAL APT 1321
Second Line	:
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94040-6247
Country	:	US
Telephone Number	:	775-722-8588
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2025
Last Update Date	:	03/31/2025

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Directions to “ JACOB JOSEPH LEWIS ” Practice Location

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