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General NPI Number Information
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NPI Number | 1881067627
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Entity Type | Organization
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Legal Business Name | LIVING YOUNGER MOVMENT THERAPY, LLC
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Dates
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Enumeration Date | 11/02/2015
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Last Update Date | 03/03/2016
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Provider Practice Location Address
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Address Line | 215 S POWER RD
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City | MESA
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State | AZ
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Zip | 85206-5235
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Country | US
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Telephone | 602-821-5008
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Fax |
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Provider Business Mailing Address
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Address Line | 508 N MERRILL RD
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City | MESA
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State | AZ
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Zip | 85207-2423
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LAURA LAMB
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Credential | BS, LMT
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Telephone | 602-821-5008
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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 | MT20939
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT20953
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 8439
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 8479
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License Number State | AZ
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