Healthcare Provider Details

I. General information

NPI: 1881818102
Provider Name (Legal Business Name): LINDA T LIFSEY RMT LMT NCTMB
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 02/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2246 W 5700 S
ROY UT
84067-1503
US

IV. Provider business mailing address

2246 W 5700 S
ROY UT
84067-1503
US

V. Phone/Fax

Practice location:
  • Phone: 801-814-7889
  • Fax:
Mailing address:
  • Phone: 801-814-7889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT012028
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number5193244-4701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: