MEDICARE: ZAKKOYYA LEWIS-POWELL BS, ATC

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	2255A2300X	Athletic Trainer	2000014618	CA

General Provider Information

NPI Number	:	1821495243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZAKKOYYA LEWIS-POWELL BS, ATC

Provider Business Mailing Address
First Line	:	8100 SEAWALL BLVD
Second Line	:	APT 280
City	:	GALVESTON
State	:	TX
Zip	:	77551-2197
Country	:	US
Telephone Number	:	562-881-9950
Fax Number	:

Provider Business Practice Location Address
First Line	:	8100 SEAWALL BLVD
Second Line	:	APT 280
City	:	GALVESTON
State	:	TX
Zip	:	77551-2197
Country	:	US
Telephone Number	:	562-881-9950
Fax Number	:

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

Provider Enumeration Date	:	12/01/2014
Last Update Date	:	12/01/2014

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