Healthcare Provider Details

I. General information

NPI: 1750125779
Provider Name (Legal Business Name): WESTON A JOHNSON MT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 S MAIN ST
CEDAR CITY UT
84720-3726
US

IV. Provider business mailing address

259 N 300 W APT 4
CEDAR CITY UT
84721-3512
US

V. Phone/Fax

Practice location:
  • Phone: 435-592-2221
  • Fax:
Mailing address:
  • Phone: 435-868-7025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number11699431-4701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: