MEDICARE: ANDREA YOUNG L.M.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	2010010227	MO

General Provider Information

NPI Number	:	1033439401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA YOUNG L.M.T.

Provider Business Mailing Address
First Line	:	19 E WALNUT ST
Second Line	:	C
City	:	COLUMBIA
State	:	MO
Zip	:	65203-4505
Country	:	US
Telephone Number	:	573-355-6636
Fax Number	:

Provider Business Practice Location Address
First Line	:	19 E WALNUT ST
Second Line	:	C
City	:	COLUMBIA
State	:	MO
Zip	:	65203-4505
Country	:	US
Telephone Number	:	573-355-6636
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2010
Last Update Date	:	12/28/2010

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