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General NPI Number Information
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NPI Number | 1669277869
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Entity Type | Individual
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Provider Name | DAVID MOOYOUNG LMBT
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Gender | Male
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Dates
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Enumeration Date | 02/13/2025
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 1819 PEMBROKE RD
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City | GREENSBORO
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State | NC
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Zip | 27408-7901
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Country | US
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Telephone | 509-310-9421
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Fax |
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Provider Business Mailing Address
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Address Line | 1110 WILKINS ST
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City | MAYODAN
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State | NC
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Zip | 27027-2056
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Country | US
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Telephone | 509-310-9421
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 10030
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License Number State | NC
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