Provider Demographics
NPI:1114577848
Name:LEWIS, ROSS G (LMT)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:G
Last Name:LEWIS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 S PERSHING DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-1308
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PLIENINGERSTRASSE 12
Practice Address - Street 2:APT 3
Practice Address - City:FRANKFURT
Practice Address - State:AM MAIN
Practice Address - Zip Code:60320
Practice Address - Country:DE
Practice Address - Phone:515-857-5080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-15
Last Update Date:2019-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019013995225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist