1225367824 NPI number — PAULETTE DAWN LEWIS LMT

Table of content: STEPHEN HADZIMA (NPI 1568572550)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225367824 NPI number — PAULETTE DAWN LEWIS LMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEWIS
Provider First Name:
PAULETTE
Provider Middle Name:
DAWN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225367824
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3429 NW 32ND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAUDERDALE LAKES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33309-5423
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-629-7764
Provider Business Mailing Address Fax Number:
954-484-7764

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
570 OCEAN DR
Provider Second Line Business Practice Location Address:
#501
Provider Business Practice Location Address City Name:
JUNO BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33408-1952
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-491-2225
Provider Business Practice Location Address Fax Number:
954-491-6862
Provider Enumeration Date:
12/10/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MA50847 . This is a "LICENSED MASSAGE THERAPIST" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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