Provider Demographics
NPI:1518672427
Name:THOMPSON, LEWIS JR
Entity Type:Individual
Prefix:
First Name:LEWIS
Middle Name:
Last Name:THOMPSON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 E BURNSIDE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2576
Mailing Address - Country:US
Mailing Address - Phone:503-314-9297
Mailing Address - Fax:971-319-2195
Practice Address - Street 1:2311 E BURNSIDE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2576
Practice Address - Country:US
Practice Address - Phone:503-314-9297
Practice Address - Fax:971-319-2195
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR27249OtherLICENSE