Healthcare Provider Details

I. General information

NPI: 1508721119
Provider Name (Legal Business Name): TRACY LYNN LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3845 TRUEMAN CT
HILLIARD OH
43026-2496
US

IV. Provider business mailing address

3845 TRUEMAN CT
HILLIARD OH
43026-2496
US

V. Phone/Fax

Practice location:
  • Phone: 614-767-0162
  • Fax: 614-767-0164
Mailing address:
  • Phone: 614-767-0162
  • Fax: 614-767-0164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33.027686
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: