| Doctor Name: | MR. LADON STACY LEWIS |
| NPI Number: | 1104084300 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | L.M.T. |
| License Number: | MA52351 |
| Business Practice Address: | 3650 Nantucket Island Dr Apt. 101 Port Orange, FL - 321295336 |
| Business Phone Number: | 3866794996 |
| Business Fax Number: | 3863223870 |
| Mailing Address: | Po Box 422, DAYTONA BEACH |
| State: | FL |
| Postal Code: | 321150422 |
| Phone Number: | 3866794996 |
| Fax Number: | 3863223870 |
| NPI Enumeration Date: | 05/26/2008 |
| NPI Last Update Date: | 05/26/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225700000X |
| License Number: | MA52351 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Massage Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |