Provider Demographics
NPI:1093016875
Name:LAMONT, MARK (LMT, NCTMB)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:LAMONT
Suffix:
Gender:M
Credentials:LMT, NCTMB
Other - Prefix:MR
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:LAMONT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT, NCTMB
Mailing Address - Street 1:420 E SOUTH TEMPLE STE 240
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-1319
Mailing Address - Country:US
Mailing Address - Phone:801-364-2000
Mailing Address - Fax:801-364-2001
Practice Address - Street 1:420 E SOUTH TEMPLE STE 240
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-1319
Practice Address - Country:US
Practice Address - Phone:801-364-2000
Practice Address - Fax:801-364-2001
Is Sole Proprietor?:No
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5838189-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist