MEDICARE: JENNIFER MARRION YOUNGS CMT

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

General Provider Information

NPI Number	:	1982978656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MARRION YOUNGS CMT

Provider Business Mailing Address
First Line	:	37686 ELEANOR AVE
Second Line	:
City	:	NORTH BRANCH
State	:	MN
Zip	:	55056-5546
Country	:	US
Telephone Number	:	651-307-1974
Fax Number	:

Provider Business Practice Location Address
First Line	:	1432 LAKE ST S
Second Line	:
City	:	FOREST LAKE
State	:	MN
Zip	:	55025-2635
Country	:	US
Telephone Number	:	651-307-1974
Fax Number	:

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

Provider Enumeration Date	:	02/28/2012
Last Update Date	:	02/28/2012

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