Provider Demographics
NPI:1720595275
Name:LEE, CINDY ELIZABETH (LMT)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:ELIZABETH
Last Name:LEE
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 1:129 E COATSVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-1924
Mailing Address - Country:US
Mailing Address - Phone:435-655-5265
Mailing Address - Fax:
Practice Address - Street 1:4427 S 2950 E
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84124-3740
Practice Address - Country:US
Practice Address - Phone:435-655-5265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-05
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8339862-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist