Healthcare Provider Details

I. General information

NPI: 1174192546
Provider Name (Legal Business Name): CLAIRISSA LYNN DAVIS LMT, MMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 N MAIN ST STE 103
CEDAR CITY UT
84721-9772
US

IV. Provider business mailing address

780 W 1125 N UNIT 19
CEDAR CITY UT
84721-8890
US

V. Phone/Fax

Practice location:
  • Phone: 435-704-1622
  • Fax:
Mailing address:
  • Phone: 435-559-9088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number10685958-4701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: