Carly Kay Kiska Lewis, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT60277346 Issued in WA

Practice address

11400 SE 6TH St
Suite 105
Bellevue, WA 98004-6423

Phone

(425) 576-8180

Fax

(425) 746-2002

NPI assigned

Jun 27, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Carly Kay Kiska Peterson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Esrc PLLC

  • Physical Therapy Clinic/Center
  • Bellevue, WA
  • NPI 1699796755

  Physical Therapist

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1340755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579651200000",
    "number": "1609130400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 KIRKLAND AVE",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980336503",
            "telephone_number": "425-419-4363",
            "fax_number": "425-419-4969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11400 SE 6TH ST",
            "address_2": "SUITE 105",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980046423",
            "telephone_number": "425-576-8180",
            "fax_number": "425-746-2002"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13315 68th Pl NE",
            "address_purpose": "LOCATION",
            "city": "Kirkland",
            "state": "WA",
            "postal_code": "980341650",
            "country_code": "US",
            "telephone_number": "877-390-6659",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEWIS",
        "first_name": "CARLY",
        "middle_name": "KAY KISKA",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-27",
        "last_updated": "2020-01-22",
        "certification_date": "2020-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT60277346",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2020740",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CARLY",
            "last_name": "PETERSON",
            "middle_name": "KAY KISKA",
            "credential": "DPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Richard Ira Levine, D.C.
• Nicole Levy, SLP
• Rona L Levy, MSW, PHD, MPH
• Michelle N Lew, ARNP
• Aliviah S Lewis
• Cheri R Lewis, LMHC, NCC
• Jodie Lewis, OTR/L
• Martine S Lewis, ARNP
• Tana P Leybold, RC
• Keith H Leyden, MD

• Physical Therapist in Bellevue, WA
• Providers in Bellevue, WA by specialty
• Physical Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.