Provider Demographics
NPI:1710934005
Name:LEWIS, EDA JANE JANUHOWSKI (PT, DPT, MS)
Entity type:Individual
Prefix:MRS
First Name:EDA
Middle Name:JANE JANUHOWSKI
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PT, DPT, MS
Other - Prefix:MRS
Other - First Name:EDA
Other - Middle Name:JANE
Other - Last Name:JANUHOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, MS
Mailing Address - Street 1:12039 RIVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-3035
Mailing Address - Country:US
Mailing Address - Phone:281-531-4064
Mailing Address - Fax:
Practice Address - Street 1:12039 RIVERVIEW DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-3035
Practice Address - Country:US
Practice Address - Phone:281-531-4064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11545792251N0400X
TX11546792251P0200X, 2251S0007X, 2251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX211596601Medicaid