Provider Demographics
NPI:1457419939
Name:LEWIS, JOEL EMERSON (PT)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:EMERSON
Last Name:LEWIS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2748 MILTON WAY STE 207
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WA
Mailing Address - Zip Code:98354-9379
Mailing Address - Country:US
Mailing Address - Phone:253-925-5623
Mailing Address - Fax:253-661-9771
Practice Address - Street 1:2748 MILTON WAY STE 207
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WA
Practice Address - Zip Code:98354-9379
Practice Address - Country:US
Practice Address - Phone:253-925-5623
Practice Address - Fax:253-661-9771
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT000057862251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA115001129Medicare ID - Type Unspecified