Provider Demographics
NPI:1558522169
Name:LEWIS, TAMMY ELAINE (PT)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:ELAINE
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:PO BOX 959
Mailing Address - Street 2:
Mailing Address - City:KETTLE FALLS
Mailing Address - State:WA
Mailing Address - Zip Code:99141-0959
Mailing Address - Country:US
Mailing Address - Phone:509-738-1555
Mailing Address - Fax:509-738-1554
Practice Address - Street 1:440 S MEYERS ST
Practice Address - Street 2:
Practice Address - City:KETTLE FALLS
Practice Address - State:WA
Practice Address - Zip Code:99141
Practice Address - Country:US
Practice Address - Phone:509-738-1555
Practice Address - Fax:509-738-1554
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00005882225100000X
WAPT0005882261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy