Provider Demographics
NPI:1346385531
Name:YOUNG, LORENA ANN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:LORENA
Middle Name:ANN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6353 ALDEA CT SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-7925
Mailing Address - Country:US
Mailing Address - Phone:360-485-3377
Mailing Address - Fax:360-438-6943
Practice Address - Street 1:6353 ALDEA CT SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-7925
Practice Address - Country:US
Practice Address - Phone:360-485-3377
Practice Address - Fax:360-943-1918
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X
WAMA00011955225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA00011955OtherSTATE LICENSE