Healthcare Provider Details

I. General information

NPI: 1730393471
Provider Name (Legal Business Name): MS. ALISHA THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 E PAGES LN #A
CENTERVILLE UT
84014-2216
US

IV. Provider business mailing address

987 N 725 E
BOUNTIFUL UT
84010-3500
US

V. Phone/Fax

Practice location:
  • Phone: 801-294-0578
  • Fax: 801-298-2147
Mailing address:
  • Phone: 801-298-5591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6189223-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: