Provider Demographics
NPI:1376073130
Name:LEWIS, MARISHA NOELLE (PTA)
Entity Type:Individual
Prefix:
First Name:MARISHA
Middle Name:NOELLE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13118 121ST WAY NE STE 201
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3004
Mailing Address - Country:US
Mailing Address - Phone:425-820-8474
Mailing Address - Fax:425-820-8054
Practice Address - Street 1:13118 121ST WAY NE
Practice Address - Street 2:SUITE 201
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3004
Practice Address - Country:US
Practice Address - Phone:425-820-8474
Practice Address - Fax:425-820-8054
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60730328225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant