MEDICARE: MR. MARK LAMONT LMT, NCTMB

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	5838189-4701	UT

General Provider Information

NPI Number	:	1093016875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK LAMONT LMT, NCTMB

Provider Business Mailing Address
First Line	:	420 E SOUTH TEMPLE STE 240
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-1319
Country	:	US
Telephone Number	:	801-364-2000
Fax Number	:	801-364-2001

Provider Business Practice Location Address
First Line	:	420 E SOUTH TEMPLE STE 240
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-1319
Country	:	US
Telephone Number	:	801-364-2000
Fax Number	:	801-364-2001

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

Provider Enumeration Date	:	11/09/2010
Last Update Date	:	11/09/2010

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