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General NPI Number Information
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NPI Number | 1801509989
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Entity Type | Individual
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Provider Name | GEOFFREY LARAY LEWIS LMT
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Gender | Male
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Dates
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Enumeration Date | 01/03/2023
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Last Update Date | 01/03/2023
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Provider Practice Location Address
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Address Line | 1004 HOBBS HWY STE 2
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City | SEMINOLE
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State | TX
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Zip | 79360-3310
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Country | US
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Telephone | 505-330-2707
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Fax |
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Provider Business Mailing Address
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Address Line | 904 SW AVENUE H
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City | SEMINOLE
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State | TX
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Zip | 79360-5224
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Country | US
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Telephone | 505-330-2707
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Fax |
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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 | 132695
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License Number State | TX
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