Provider Demographics
NPI:1982771010
Name:LEWIS, SUZANNE MAE (PT)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MAE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:MAE
Other - Last Name:WHEATLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:28700 SE 462ND PL
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-9318
Mailing Address - Country:US
Mailing Address - Phone:360-802-0244
Mailing Address - Fax:866-584-9044
Practice Address - Street 1:1427 JEFFERSON AVE
Practice Address - Street 2:SUITE B-1
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-3649
Practice Address - Country:US
Practice Address - Phone:360-802-0244
Practice Address - Fax:866-584-9044
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003760225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0169982OtherL&I
WA8869537Medicare UPIN