Provider Demographics
NPI:1528224920
Name:LEWIS, MELISSA ELAINE (DPT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ELAINE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ELAINE
Other - Last Name:DAWSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2405 SE CENTURY BLVD
Mailing Address - Street 2:#109
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-8294
Mailing Address - Country:US
Mailing Address - Phone:971-245-6845
Mailing Address - Fax:971-249-3041
Practice Address - Street 1:2405 SE CENTURY BLVD
Practice Address - Street 2:#109
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-8294
Practice Address - Country:US
Practice Address - Phone:971-245-6845
Practice Address - Fax:971-249-3041
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR602912251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics