Provider Demographics
NPI:1881818102
Name:LIFSEY, LINDA T (RMT LMT NCTMB)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:T
Last Name:LIFSEY
Suffix:
Gender:F
Credentials:RMT LMT NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2246 W 5700 S
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-1503
Mailing Address - Country:US
Mailing Address - Phone:801-814-7889
Mailing Address - Fax:
Practice Address - Street 1:2246 W 5700 S
Practice Address - Street 2:
Practice Address - City:ROY
Practice Address - State:UT
Practice Address - Zip Code:84067-1503
Practice Address - Country:US
Practice Address - Phone:801-814-7889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2008-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT012028225700000X
UT5193244-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist