Healthcare Provider Details

I. General information

NPI: 1760329338
Provider Name (Legal Business Name): MATHEW CROFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14241 S REDWOOD RD STE 125
BLUFFDALE UT
84065-5263
US

IV. Provider business mailing address

14241 S REDWOOD RD STE 125
BLUFFDALE UT
84065-5263
US

V. Phone/Fax

Practice location:
  • Phone: 801-949-4449
  • Fax: 801-972-0510
Mailing address:
  • Phone: 801-949-4449
  • Fax: 801-972-0510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number13565126-4701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: