Provider Demographics
NPI:1609122167
Name:LEWIS, JOSHUA RYAN (MS, ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:RYAN
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 47TH ST SE
Mailing Address - Street 2:G205
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-8606
Mailing Address - Country:US
Mailing Address - Phone:307-871-5030
Mailing Address - Fax:
Practice Address - Street 1:703 47TH ST SE
Practice Address - Street 2:G205
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98092-8606
Practice Address - Country:US
Practice Address - Phone:307-871-5030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAA1601849102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer