Provider Demographics
NPI:1164465126
Name:LEWIS, EDWARD JAMES (ATC)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:JAMES
Last Name:LEWIS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5735 SW 170TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97007-3318
Mailing Address - Country:US
Mailing Address - Phone:503-681-4260
Mailing Address - Fax:503-693-2330
Practice Address - Street 1:1200 NE 48TH AVE
Practice Address - Street 2:SUITE 700
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-4904
Practice Address - Country:US
Practice Address - Phone:503-312-2616
Practice Address - Fax:503-693-2330
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAT-AT-1423012255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer