Doctor Name: | MR. BENJAMIN DEAN LEWIS |
NPI Number: | 1992964894 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | L.M.T., M.M.P. |
License Number: | |
Business Practice Address: | 2539 Channing Way Suite 102 Idaho Falls, ID - 834047544 |
Business Phone Number: | 2084032262 |
Business Fax Number: | |
Mailing Address: | 2539 Channing Way, Suite 102 IDAHO FALLS |
State: | ID |
Postal Code: | 834047544 |
Phone Number: | 2084032262 |
Fax Number: | |
NPI Enumeration Date: | 06/05/2008 |
NPI Last Update Date: | 06/05/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
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. |