Healthcare Provider Details

I. General information

NPI: 1316484082
Provider Name (Legal Business Name): JUDITH KAPLER BISHOP LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2017
Last Update Date: 01/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 MICHIE LN
MIDWAY UT
84049-6710
US

IV. Provider business mailing address

850 MICHIE LN
MIDWAY UT
84049-6710
US

V. Phone/Fax

Practice location:
  • Phone: 435-655-5410
  • Fax:
Mailing address:
  • Phone: 435-655-5410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7765002-4701
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT010626
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: