Provider Demographics
NPI:1831533462
Name:LEWIS, RONDA LUCIA (MRP)
Entity type:Individual
Prefix:MS
First Name:RONDA
Middle Name:LUCIA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MRP
Other - Prefix:PROF
Other - First Name:RONDA
Other - Middle Name:LUCIA
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MRP
Mailing Address - Street 1:642 E CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:RIDLEY PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19078-1701
Mailing Address - Country:US
Mailing Address - Phone:757-748-1998
Mailing Address - Fax:
Practice Address - Street 1:2005 ROUTE 70 E
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-1279
Practice Address - Country:US
Practice Address - Phone:757-748-1998
Practice Address - Fax:610-522-6478
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-25
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2021173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist