Provider Demographics
NPI:1649639733
Name:LEWIS, SHARON MARIE (LMT)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:MARIE
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 1:1600 LENA ST STE C6
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4338
Mailing Address - Country:US
Mailing Address - Phone:505-216-6247
Mailing Address - Fax:
Practice Address - Street 1:1600 LENA ST STE C6
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4338
Practice Address - Country:US
Practice Address - Phone:505-216-6247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM7763225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM7763OtherMN MASSAGE THERAPY LIC #