MEDICARE: MRS. LINDA S LEWIS LMT

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	225700000X	Massage Therapist	5570	NC

General Provider Information

NPI Number	:	1457586745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LINDA S LEWIS LMT

Provider Business Mailing Address
First Line	:	3820 RIDGECREST DR
Second Line	:
City	:	SOUTHPORT
State	:	NC
Zip	:	28461-9059
Country	:	US
Telephone Number	:	910-228-4666
Fax Number	:

Provider Business Practice Location Address
First Line	:	8809 E OAK ISLAND DR
Second Line	:
City	:	OAK ISLAND
State	:	NC
Zip	:	28465-8369
Country	:	US
Telephone Number	:	910-278-5877
Fax Number	:

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

Provider Enumeration Date	:	05/15/2009
Last Update Date	:	05/15/2009

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