Provider Demographics
NPI:1902017106
Name:LEWIS, CLARE (PT)
Entity Type:Individual
Prefix:
First Name:CLARE
Middle Name:
Last Name:LEWIS
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 1:3127 SPINNING ROD WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833-9625
Mailing Address - Country:US
Mailing Address - Phone:916-359-3127
Mailing Address - Fax:
Practice Address - Street 1:2945 BELL ROAD
Practice Address - Street 2:# 215
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603
Practice Address - Country:US
Practice Address - Phone:916-367-1888
Practice Address - Fax:530-888-0885
Is Sole Proprietor?:No
Enumeration Date:2007-05-28
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24309103TC0700X
CAPT10647225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist