MEDICARE: KONI CHRISTENSEN LMT, CHES

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	174H00000X	Health Educator	22637	UT
2	225700000X	Massage Therapist	5545539-4701	UT

General Provider Information

NPI Number	:	1942787007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KONI CHRISTENSEN LMT, CHES

Provider Business Mailing Address
First Line	:	PO BOX 13044
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84412-3044
Country	:	US
Telephone Number	:	208-406-8461
Fax Number	:

Provider Business Practice Location Address
First Line	:	5138 W DAY PARK DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84120-2830
Country	:	US
Telephone Number	:	208-406-8461
Fax Number	:

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

Provider Enumeration Date	:	07/22/2018
Last Update Date	:	07/22/2018

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