MEDICARE: MS. KIMBERLY OWENS LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	359642-4701	UT

General Provider Information

NPI Number	:	1205799905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIMBERLY OWENS LMT

Provider Business Mailing Address
First Line	:	652 W 800 N APT 124
Second Line	:
City	:	CLINTON
State	:	UT
Zip	:	84015-9478
Country	:	US
Telephone Number	:	801-725-7985
Fax Number	:

Provider Business Practice Location Address
First Line	:	360 S FORT LN # B-106
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-4259
Country	:	US
Telephone Number	:	801-725-7985
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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