Healthcare Provider Details

I. General information

NPI: 1407376668
Provider Name (Legal Business Name): L:YMPHATIC SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2017
Last Update Date: 06/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 S 300 E STE 101
ST GEORGE UT
84770-2948
US

IV. Provider business mailing address

PO BOX 503
SANTA CLARA UT
84765-0503
US

V. Phone/Fax

Practice location:
  • Phone: 435-674-7515
  • Fax: 435-674-7565
Mailing address:
  • Phone: 435-674-7515
  • Fax: 435-674-7565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARK J. YOUNGBERG
Title or Position: OWNER
Credential:
Phone: 435-674-7515