Healthcare Provider Details

I. General information

NPI: 1851309918
Provider Name (Legal Business Name): SHERRY BELLE KENWORTHY L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 W 1175 N A44
CEDAR CITY UT
84720-8948
US

IV. Provider business mailing address

236 W 1175 N A44
CEDAR CITY UT
84720-8948
US

V. Phone/Fax

Practice location:
  • Phone: 435-463-8501
  • Fax:
Mailing address:
  • Phone: 435-586-9846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number56960214701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: