MEDICARE: LETA MARIE SAUL NEUMAN LMT

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	6626518-4701	UT

General Provider Information

NPI Number	:	1083920847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LETA MARIE SAUL NEUMAN LMT

Provider Business Mailing Address
First Line	:	5329 RUSTIC DR
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84123-4452
Country	:	US
Telephone Number	:	801-979-9018
Fax Number	:	510-991-9018

Provider Business Practice Location Address
First Line	:	1331 S STATE ST
Second Line	:	SUITE 105A
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84115-5477
Country	:	US
Telephone Number	:	801-979-9018
Fax Number	:	510-991-9018

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

Provider Enumeration Date	:	08/31/2010
Last Update Date	:	08/31/2010

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