Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 120505-2401 | UT |
Y | 213ES0000X | Sports Medicine | 120505-2401 | UT |
NPI | 1487827093 |
---|---|
Provider Name | Mrs. Lynne Michelle Margolis |
First Address | Park City, UT 84060-4103 |
Second Address | Salt Lake City, UT 84102-1507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2008 |
Last Update Date | 04/04/2008 |