Individual
AMANDA GWEN LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.T
Contact information
Practice address
1900 S HARBOR CITY BLVD, SUITE 104, MELBOURNE, FL 32901-4749
(321) 674-9900
Mailing address
1900 S. HARBOR CITY BOULEVARD, SUITE 104, MELBOURNE, FL 32901
(321) 674-9900
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA42798
FL
Other
Enumeration date
05/02/2011
Last updated
05/02/2011
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