Provider Demographics
NPI:1467699132
Name:LEWIS, LORRAINE (MT)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 SW CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2917
Mailing Address - Country:US
Mailing Address - Phone:772-233-9933
Mailing Address - Fax:
Practice Address - Street 1:413 SW CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2917
Practice Address - Country:US
Practice Address - Phone:772-233-9933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA11976225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist