Provider Demographics
NPI:1851679179
Name:REGEN, LEWIS (CMT)
Entity type:Individual
Prefix:
First Name:LEWIS
Middle Name:
Last Name:REGEN
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 OAK DR
Mailing Address - Street 2:
Mailing Address - City:FELTON
Mailing Address - State:CA
Mailing Address - Zip Code:95018-9152
Mailing Address - Country:US
Mailing Address - Phone:183-133-4505
Mailing Address - Fax:
Practice Address - Street 1:750 OAK DR
Practice Address - Street 2:
Practice Address - City:FELTON
Practice Address - State:CA
Practice Address - Zip Code:95018-9152
Practice Address - Country:US
Practice Address - Phone:831-334-5050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA012-34-2193225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist