Provider Demographics
NPI:1639972797
Name:LEWIS, JACOB JOSEPH
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:JOSEPH
Last Name:LEWIS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2260 W EL CAMINO REAL APT 1321
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-6247
Mailing Address - Country:US
Mailing Address - Phone:775-722-8588
Mailing Address - Fax:
Practice Address - Street 1:2260 W EL CAMINO REAL APT 1321
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-6247
Practice Address - Country:US
Practice Address - Phone:775-722-8588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVA-1381225200000X
CA53800225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant