Provider Demographics
NPI:1710476247
Name:LEWIS, CORAL JENNIFER (MPT)
Entity Type:Individual
Prefix:
First Name:CORAL
Middle Name:JENNIFER
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NE NORTHLAKE WAY STE 200B
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-6869
Mailing Address - Country:US
Mailing Address - Phone:206-547-7445
Mailing Address - Fax:
Practice Address - Street 1:100 NE NORTHLAKE WAY STE 200B
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105
Practice Address - Country:US
Practice Address - Phone:206-547-7445
Practice Address - Fax:206-913-2486
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA608222942251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic