Provider Demographics
NPI:1528209640
Name:LEWIS, JENNIE JOY (CMT)
Entity Type:Individual
Prefix:MS
First Name:JENNIE
Middle Name:JOY
Last Name:LEWIS
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 ELENA LN
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MN
Mailing Address - Zip Code:56374-4407
Mailing Address - Country:US
Mailing Address - Phone:320-281-0046
Mailing Address - Fax:
Practice Address - Street 1:426 ELENA LN
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MN
Practice Address - Zip Code:56374-4407
Practice Address - Country:US
Practice Address - Phone:320-281-0046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-19
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist