Provider Demographics
NPI:1417654435
Name:LEWIS, KELLY (LMT, CPM, NCTMB, CCM)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LMT, CPM, NCTMB, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 GLENWOOD ST STE 101
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-1300
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9200 GLENWOOD ST STE 101
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-1300
Practice Address - Country:US
Practice Address - Phone:913-424-8517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist