Provider Demographics
NPI:1417254210
Name:LEWIS, RACHEL DANETTE (LMT, NBCHT, BW, HB,)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:DANETTE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LMT, NBCHT, BW, HB,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 S MARION AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-7064
Mailing Address - Country:US
Mailing Address - Phone:386-719-8887
Mailing Address - Fax:386-438-8732
Practice Address - Street 1:322 S MARION AVE
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-7064
Practice Address - Country:US
Practice Address - Phone:386-719-8887
Practice Address - Fax:386-438-8732
Is Sole Proprietor?:No
Enumeration Date:2011-02-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA61220225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist