Provider Demographics
NPI:1710934005
Name:LEWIS, EDA JANE JANUHOWSKI (PT, DPT, MS)
Entity Type:Individual
Prefix:MRS
First Name:EDA
Middle Name:JANE JANUHOWSKI
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PT, DPT, MS
Other - Prefix:MRS
Other - First Name:EDA
Other - Middle Name:JANE
Other - Last Name:JANUHOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, MS
Mailing Address - Street 1:12039 RIVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-3035
Mailing Address - Country:US
Mailing Address - Phone:281-531-4064
Mailing Address - Fax:
Practice Address - Street 1:12039 RIVERVIEW DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-3035
Practice Address - Country:US
Practice Address - Phone:281-531-4064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1154679225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX211596601Medicaid