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General NPI Number Information
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NPI Number | 1851530133
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Entity Type | Individual
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Provider Name | MARY LOU YOUNG LMT
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Gender | Female
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Dates
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Enumeration Date | 02/11/2009
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Last Update Date | 02/11/2009
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Provider Practice Location Address
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Address Line | 4583 NORTH ST
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City | JAMESVILLE
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State | NY
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Zip | 13078-9461
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Country | US
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Telephone | 315-430-3942
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 236 2814 GARDNER RD
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City | POMPEY
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State | NY
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Zip | 13138
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Country | US
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Telephone | 315-430-3942
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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 | 013872
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License Number State | NY
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