Provider Demographics
NPI:1043402902
Name:LEWIS, ROXANN M (LMP)
Entity Type:Individual
Prefix:
First Name:ROXANN
Middle Name:M
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33566 36TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-2904
Mailing Address - Country:US
Mailing Address - Phone:253-838-1235
Mailing Address - Fax:253-838-4254
Practice Address - Street 1:33606 PACIFIC HWY S
Practice Address - Street 2:#4
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6874
Practice Address - Country:US
Practice Address - Phone:253-838-1235
Practice Address - Fax:253-838-4254
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00011748225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA130554OtherL & I PIN