Provider Demographics
NPI:1144796251
Name:LEWIS, RACHEL (ATC, LMT)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:ATC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4229 N BUFFALO RD REAR
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-2450
Mailing Address - Country:US
Mailing Address - Phone:716-713-2882
Mailing Address - Fax:
Practice Address - Street 1:4229 N BUFFALO RD REAR
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-2450
Practice Address - Country:US
Practice Address - Phone:716-713-2882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00024562255A2300X
NY031274225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer