Healthcare Provider Details

I. General information

NPI: 1093629362
Provider Name (Legal Business Name): RAYMOND LEWIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1577 W 7000 S STE 100
WEST JORDAN UT
84084-7493
US

IV. Provider business mailing address

1577 W 7000 S STE 100
WEST JORDAN UT
84084-7493
US

V. Phone/Fax

Practice location:
  • Phone: 801-566-6301
  • Fax: 801-566-4739
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number14307675-4701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: