Basic Information
| Provider Information | |||||||||
| NPI: | 1376073130 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | MARISHA | ||||||||
| MiddleName: | NOELLE | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13118 121ST WAY NE STE 201 | ||||||||
| Address2: | |||||||||
| City: | KIRKLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980343004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4258208474 | ||||||||
| FaxNumber: | 4258208054 | ||||||||
| Practice Location | |||||||||
| Address1: | 13118 121ST WAY NE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | KIRKLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980343004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4258208474 | ||||||||
| FaxNumber: | 4258208054 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2017 | ||||||||
| LastUpdateDate: | 06/14/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | PT60730328 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.