Provider Demographics
NPI:1679931943
Name:LEWIS, JARVIS B (LMT)
Entity Type:Individual
Prefix:MR
First Name:JARVIS
Middle Name:B
Last Name:LEWIS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 S REED ST
Mailing Address - Street 2:UNIT H
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80232-5577
Mailing Address - Country:US
Mailing Address - Phone:720-358-4440
Mailing Address - Fax:
Practice Address - Street 1:1140 S REED ST
Practice Address - Street 2:UNIT H
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80232-5577
Practice Address - Country:US
Practice Address - Phone:478-444-8624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0017429225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist