MEDICARE: JOSHUA KING 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	8298267-4701	UT

General Provider Information

NPI Number	:	1629478862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA KING L.M.T

Provider Business Mailing Address
First Line	:	5801 S FASHION BLVD STE 175
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84107-8115
Country	:	US
Telephone Number	:	801-910-6683
Fax Number	:

Provider Business Practice Location Address
First Line	:	5801 S FASHION BLVD STE 175
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84107-8115
Country	:	US
Telephone Number	:	801-910-6683
Fax Number	:

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

Provider Enumeration Date	:	08/25/2014
Last Update Date	:	08/25/2014

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