Provider Demographics
NPI:1780934745
Name:LEWIS, JODY (CMT)
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 S MONROE ST
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-1908
Mailing Address - Country:US
Mailing Address - Phone:517-278-5300
Mailing Address - Fax:517-278-8997
Practice Address - Street 1:12 S MONROE ST
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-1908
Practice Address - Country:US
Practice Address - Phone:517-278-5300
Practice Address - Fax:517-278-8997
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist