Provider Demographics
NPI:1588177562
Name:LEWIS, SHOSHANNA DANICA (DPT)
Entity Type:Individual
Prefix:
First Name:SHOSHANNA
Middle Name:DANICA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1975 NW 167TH PL
Mailing Address - Street 2:# 100-43
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-4908
Mailing Address - Country:US
Mailing Address - Phone:971-205-2630
Mailing Address - Fax:971-606-2024
Practice Address - Street 1:1975 NW 167TH PL
Practice Address - Street 2:# 100-43
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-4908
Practice Address - Country:US
Practice Address - Phone:971-205-2630
Practice Address - Fax:971-606-2024
Is Sole Proprietor?:No
Enumeration Date:2017-11-13
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR62541225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist