Provider Demographics
NPI:1447766027
Name:NATHAN LEWIS DPT, LLC
Entity Type:Organization
Organization Name:NATHAN LEWIS DPT, LLC
Other - Org Name:ROGUE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:541-301-2499
Mailing Address - Street 1:945 OAK ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1266
Mailing Address - Country:US
Mailing Address - Phone:541-301-2499
Mailing Address - Fax:541-500-3303
Practice Address - Street 1:14 COTTAGE ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7332
Practice Address - Country:US
Practice Address - Phone:541-301-2499
Practice Address - Fax:541-500-3303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-19
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1447766027Medicaid