Individual
IDA LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1619 SPINNAKER WAY, WYLIE, TX 75098-7985
(972) 422-2200
Mailing address
1619 SPINNAKER WAY, WYLIE, TX 75098-7985
(972) 422-2200
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT022624
TX
Other
Enumeration date
07/27/2016
Last updated
07/27/2016
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