Healthcare Provider Details

I. General information

NPI: 1689430795
Provider Name (Legal Business Name): JANEL MCKINNEY LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 03/16/2024
Certification Date: 03/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

887 MCCORMICK WAY
LAYTON UT
84041-7262
US

IV. Provider business mailing address

1406 N 475 W
SUNSET UT
84015-2824
US

V. Phone/Fax

Practice location:
  • Phone: 801-529-2012
  • Fax:
Mailing address:
  • Phone: 801-529-2012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number282686-4701
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: