Provider Demographics
NPI:1407376668
Name:L:YMPHATIC SOLUTIONS, LLC
Entity type:Organization
Organization Name:L:YMPHATIC SOLUTIONS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:YOUNGBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-674-7515
Mailing Address - Street 1:PO BOX 503
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:UT
Mailing Address - Zip Code:84765-0503
Mailing Address - Country:US
Mailing Address - Phone:435-674-7515
Mailing Address - Fax:435-674-7565
Practice Address - Street 1:63 S 300 E STE 101
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-2948
Practice Address - Country:US
Practice Address - Phone:435-674-7515
Practice Address - Fax:435-674-7565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty