Healthcare Provider Details

I. General information

NPI: 1871031062
Provider Name (Legal Business Name): LAURA FAGER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2017
Last Update Date: 02/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2113 N MAIN ST SUITE 1
CEDAR CITY UT
84721-7763
US

IV. Provider business mailing address

4716 QUICKDRAW LN
ENOCH UT
84721-7462
US

V. Phone/Fax

Practice location:
  • Phone: 435-862-8929
  • Fax:
Mailing address:
  • Phone: 801-706-2787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number9177381-4701
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number9177381-4701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: