MEDICARE: RUSSELL JENSON PAPPAS LMT, NCTMB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	6254871-4701	UT

General Provider Information

NPI Number	:	1588820617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUSSELL JENSON PAPPAS LMT, NCTMB

Provider Business Mailing Address
First Line	:	475 N REDWOOD RD UNIT 46
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84116-3766
Country	:	US
Telephone Number	:	503-440-9022
Fax Number	:

Provider Business Practice Location Address
First Line	:	475 N REDWOOD RD UNIT 46
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84116-3766
Country	:	US
Telephone Number	:	503-440-9022
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2008
Last Update Date	:	07/29/2008

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