Provider Demographics
NPI:1225367824
Name:LEWIS, PAULETTE DAWN (LMT)
Entity Type:Individual
Prefix:
First Name:PAULETTE
Middle Name:DAWN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3429 NW 32ND ST
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33309-5423
Mailing Address - Country:US
Mailing Address - Phone:954-629-7764
Mailing Address - Fax:954-484-7764
Practice Address - Street 1:570 OCEAN DR
Practice Address - Street 2:#501
Practice Address - City:JUNO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-1952
Practice Address - Country:US
Practice Address - Phone:954-491-2225
Practice Address - Fax:954-491-6862
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA50847OtherLICENSED MASSAGE THERAPIST