MEDICARE: JOSEPH 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	7436	SC

General Provider Information

NPI Number	:	1780462994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH LEWIS LMT

Provider Business Mailing Address
First Line	:	1997 ROSELLA LN
Second Line	:
City	:	CONWAY
State	:	SC
Zip	:	29526-8224
Country	:	US
Telephone Number	:	843-424-9199
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 HIGHWAY 17 N STE 201
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-8107
Country	:	US
Telephone Number	:	843-489-0788
Fax Number	:

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

Provider Enumeration Date	:	09/19/2023
Last Update Date	:	09/19/2023

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Directions to “ JOSEPH LEWIS LMT” Practice Location

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