Individual
MR. BRANT WALTER LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
14851 SE 82ND DR, CLACKAMAS, OR 97015-7624
(503) 656-0139
(503) 557-4871
Mailing address
14851 SE 82ND DR, CLACKAMAS, OR 97015-7624
(503) 656-0139
(503) 557-4871
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1870
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007646
—
OR
Enumeration date
11/22/2006
Last updated
07/08/2007
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