Provider Demographics
NPI:1194569145
Name:LEWIS, SADIE R
Entity type:Individual
Prefix:
First Name:SADIE
Middle Name:R
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-3010
Mailing Address - Country:US
Mailing Address - Phone:906-228-2765
Mailing Address - Fax:866-519-2120
Practice Address - Street 1:1208 N 3RD ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-3010
Practice Address - Country:US
Practice Address - Phone:906-228-2765
Practice Address - Fax:866-519-2120
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501013093225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist