Healthcare Provider Details

I. General information

NPI: 1578282083
Provider Name (Legal Business Name): WESTSIDE THERAPEUTIC MASSAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2022
Last Update Date: 08/26/2022
Certification Date: 08/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 NORTH 2000 WEST SUITE J
CLINTON UT
84015-8562
US

IV. Provider business mailing address

1407 NORTH 2000 WEST SUITE J
CLINTON UT
84015-8562
US

V. Phone/Fax

Practice location:
  • Phone: 801-784-5777
  • Fax: 801-784-5778
Mailing address:
  • Phone: 801-784-5777
  • Fax: 801-784-5778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. YOLANDA BROWN
Title or Position: OWNER, THERAPIST
Credential: LMT
Phone: 801-784-5777