Provider Demographics
NPI:1376199695
Name:LEWIS, TAMMY J (BCTMB)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:J
Last Name:LEWIS
Suffix:
Gender:F
Credentials:BCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4740 FLINTRIDGE DR STE 130
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-4273
Mailing Address - Country:US
Mailing Address - Phone:719-917-1000
Mailing Address - Fax:
Practice Address - Street 1:4740 FLINTRIDGE DR STE 120
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-4254
Practice Address - Country:US
Practice Address - Phone:719-917-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-13
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist