MEDICARE: ELIZABETH 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	333367-4701	UT

General Provider Information

NPI Number	:	1861897407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH YOUNG LMT

Provider Business Mailing Address
First Line	:	10061 S MAJESTIC CANYON RD
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84092-4523
Country	:	US
Telephone Number	:	435-559-3484
Fax Number	:

Provider Business Practice Location Address
First Line	:	590 S WAKARA WAY
Second Line	:
City	:	SLC
State	:	UT
Zip	:	84108-1200
Country	:	US
Telephone Number	:	435-559-3484
Fax Number	:

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

Provider Enumeration Date	:	10/24/2014
Last Update Date	:	10/27/2014

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Directions to “ ELIZABETH YOUNG LMT” Practice Location

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