Healthcare Provider Details

I. General information

NPI: 1265357313
Provider Name (Legal Business Name): SARAH WILSON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARAH WALL LMT

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 S MAIN ST
ALPINE UT
84004-1682
US

IV. Provider business mailing address

222 E 100 S
PLEASANT GROVE UT
84062-2714
US

V. Phone/Fax

Practice location:
  • Phone: 801-216-4299
  • Fax:
Mailing address:
  • Phone: 435-574-7731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number13773217-4701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: