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General NPI Number Information
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NPI Number | 1649798083
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Entity Type | Individual
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Provider Name | BRIAN JOSEPH LEWIS LMT, NBCHT, PT
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Gender | Male
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Dates
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Enumeration Date | 09/06/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 322 S MARION AVE
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City | LAKE CITY
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State | FL
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Zip | 32025-7064
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Country | US
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Telephone | 386-719-8887
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Fax | 386-438-8732
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Provider Business Mailing Address
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Address Line | 322 S MARION AVE
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City | LAKE CITY
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State | FL
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Zip | 32025-7064
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Country | US
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Telephone | 386-719-8887
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Fax | 386-438-8732
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA60365
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License Number State | FL
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