Provider Demographics
NPI:1992964894
Name:LEWIS, BENJAMIN DEAN (LMT, MMP)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:DEAN
Last Name:LEWIS
Suffix:
Gender:M
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2539 CHANNING WAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7544
Mailing Address - Country:US
Mailing Address - Phone:208-403-2262
Mailing Address - Fax:
Practice Address - Street 1:2539 CHANNING WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7544
Practice Address - Country:US
Practice Address - Phone:208-403-2262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist