MEDICARE: MELISSA YOUNG 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	4925-146	WI

General Provider Information

NPI Number	:	1497161095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA YOUNG LMT

Provider Business Mailing Address
First Line	:	4359 S HOWELL AVE
Second Line	:	SUITE 203
City	:	MILWAUKEE
State	:	WI
Zip	:	53207-5056
Country	:	US
Telephone Number	:	414-737-4765
Fax Number	:

Provider Business Practice Location Address
First Line	:	4359 S HOWELL AVE
Second Line	:	SUITE 203
City	:	MILWAUKEE
State	:	WI
Zip	:	53207-5056
Country	:	US
Telephone Number	:	414-737-4765
Fax Number	:

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

Provider Enumeration Date	:	07/03/2014
Last Update Date	:	07/03/2014

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Directions to “ MELISSA YOUNG LMT” Practice Location

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