MEDICARE: LAWRENCE EDWARD 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	MT2273	DC
2	225700000X	Massage Therapist	R02723	MD

General Provider Information

NPI Number	:	1730845751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAWRENCE EDWARD LEWIS LMT

Provider Business Mailing Address
First Line	:	1915 FEATHERWOOD ST
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-6644
Country	:	US
Telephone Number	:	240-543-2343
Fax Number	:

Provider Business Practice Location Address
First Line	:	8120 FENTON ST STE 301D
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-4796
Country	:	US
Telephone Number	:	240-543-2343
Fax Number	:

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

Provider Enumeration Date	:	11/14/2021
Last Update Date	:	11/14/2021

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Directions to “ LAWRENCE EDWARD LEWIS LMT” Practice Location

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