Healthcare Provider Details

I. General information

NPI: 1073874053
Provider Name (Legal Business Name): TAYLOR R YOUNGERS LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 06/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 ALDER ST NW
EPHRATA WA
98823-1663
US

IV. Provider business mailing address

32 NOB HILL DR
EPHRATA WA
98823-1752
US

V. Phone/Fax

Practice location:
  • Phone: 509-754-3295
  • Fax: 509-754-3296
Mailing address:
  • Phone: 509-237-3977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60291514
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: