Healthcare Provider Details

I. General information

NPI: 1841819281
Provider Name (Legal Business Name): SUSAN SAXTON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2020
Last Update Date: 04/15/2020
Certification Date: 04/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4689 N OLD SCOUT TRL
ENOCH UT
84721-9802
US

IV. Provider business mailing address

4689 N OLD SCOUT TRL
ENOCH UT
84721-9802
US

V. Phone/Fax

Practice location:
  • Phone: 435-659-8246
  • Fax:
Mailing address:
  • Phone: 435-659-8246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number309589-4701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: