Provider Demographics
NPI:1467932053
Name:MADSEN, MARGARET (LMT)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:MADSEN
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 1:1199 S SANTA YNEZ CIR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84104-2086
Mailing Address - Country:US
Mailing Address - Phone:801-359-5149
Mailing Address - Fax:
Practice Address - Street 1:150 S 600 E STE 3B
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1961
Practice Address - Country:US
Practice Address - Phone:801-359-5149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8195048-4071225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist