Provider Demographics
NPI:1851036107
Name:LEWIS, SABRINA CHEVETTE (CMT)
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:CHEVETTE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:SABRINA
Other - Middle Name:CHEVETTE
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CMT
Mailing Address - Street 1:2618 63RD AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-1415
Mailing Address - Country:US
Mailing Address - Phone:510-529-8180
Mailing Address - Fax:
Practice Address - Street 1:2618 63RD AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-1415
Practice Address - Country:US
Practice Address - Phone:510-529-8180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89905225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA89905OtherCALIFORNIA MASSAGE THERAPY COUNCIL