Healthcare Provider Details

I. General information

NPI: 1699683144
Provider Name (Legal Business Name): LYNDSY ANN VAN DAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 S 200 W
WELLSVILLE UT
84339-9705
US

IV. Provider business mailing address

595 S 200 W
WELLSVILLE UT
84339-9705
US

V. Phone/Fax

Practice location:
  • Phone: 435-374-6240
  • Fax:
Mailing address:
  • Phone: 435-374-6240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number14304764-4701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: