Provider Demographics
NPI:1548867625
Name:JUNGE, CAROLYN S (LMT, CFMP)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:S
Last Name:JUNGE
Suffix:
Gender:F
Credentials:LMT, CFMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 N CAPITOL PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-5206
Mailing Address - Country:US
Mailing Address - Phone:801-835-2274
Mailing Address - Fax:
Practice Address - Street 1:I. J. & JEANNE WAGNER JEWISH COMMUNITY CENTER
Practice Address - Street 2:2 NORTH MEDICAL DRIVE
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84113-8411
Practice Address - Country:US
Practice Address - Phone:801-581-0098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175F00000X, 2255A2300X, 133NN1002X
UT11168202-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
No175F00000XOther Service ProvidersNaturopath
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty