Provider Demographics
NPI:1437236619
Name:LEWIS, MICHAEL D (MS, PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1529 3RD ST
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-5575
Mailing Address - Country:US
Mailing Address - Phone:206-992-7291
Mailing Address - Fax:425-820-2111
Practice Address - Street 1:12707 120TH AVE NE
Practice Address - Street 2:SUITE 100
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7500
Practice Address - Country:US
Practice Address - Phone:425-820-2110
Practice Address - Fax:425-820-2111
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008138225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7096613Medicaid
WA7096613Medicaid
WAAB15759Medicare ID - Type UnspecifiedPHYSICAL THERAPIST