Provider Demographics
NPI:1265900658
Name:LEWIS, LATOYA (LMT)
Entity type:Individual
Prefix:MS
First Name:LATOYA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 MEDFORD STREET SUITE 4B
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143
Mailing Address - Country:US
Mailing Address - Phone:617-431-6616
Mailing Address - Fax:
Practice Address - Street 1:343 MEDFORD STREET SUITE 4B
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143
Practice Address - Country:US
Practice Address - Phone:617-431-6616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6966225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist