Provider Demographics
NPI:1083369342
Name:LEWIS, SARAH LYNNE (LMT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:LYNNE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:SADIE
Other - Middle Name:LYNNE
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:1731 BAYFIELD PKWY APT 2
Mailing Address - Street 2:
Mailing Address - City:BAYFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:81122-9414
Mailing Address - Country:US
Mailing Address - Phone:970-739-8220
Mailing Address - Fax:
Practice Address - Street 1:175 S CLOVER DR STE 5
Practice Address - Street 2:
Practice Address - City:BAYFIELD
Practice Address - State:CO
Practice Address - Zip Code:81122-8758
Practice Address - Country:US
Practice Address - Phone:970-739-8220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0024444225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist