MEDICARE: MS. JENNIE JOY LEWIS C.M.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1528209640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIE JOY LEWIS C.M.T.

Provider Business Mailing Address
First Line	:	426 ELENA LN
Second Line	:
City	:	SAINT JOSEPH
State	:	MN
Zip	:	56374-4407
Country	:	US
Telephone Number	:	320-281-0046
Fax Number	:

Provider Business Practice Location Address
First Line	:	426 ELENA LN
Second Line	:
City	:	SAINT JOSEPH
State	:	MN
Zip	:	56374-4407
Country	:	US
Telephone Number	:	320-281-0046
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2009
Last Update Date	:	01/08/2010

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