Provider Demographics
NPI:1891802674
Name:LEW, KAREN LOUISE (PT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LOUISE
Last Name:LEW
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 HILLIGOSS CT
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-5742
Mailing Address - Country:US
Mailing Address - Phone:707-762-3465
Mailing Address - Fax:
Practice Address - Street 1:1211 N DUTTON AVE
Practice Address - Street 2:SUITE G
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4660
Practice Address - Country:US
Practice Address - Phone:707-579-1411
Practice Address - Fax:707-579-3044
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT2622225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist