Provider Demographics
NPI:1780462994
Name:LEWIS, JOSEPH (LMT)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:LEWIS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1997 ROSELLA LN
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-8224
Mailing Address - Country:US
Mailing Address - Phone:843-424-9199
Mailing Address - Fax:
Practice Address - Street 1:211 HIGHWAY 17 N STE 201
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-8107
Practice Address - Country:US
Practice Address - Phone:843-489-0788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7436225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist