Healthcare Provider Details

I. General information

NPI: 1952425308
Provider Name (Legal Business Name): SCOTT GREGORY PAUKER L.M.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 E 300 N.
MOAB UT
84532
US

IV. Provider business mailing address

P.O. BOX 867
PRICE UT
84501-0867
US

V. Phone/Fax

Practice location:
  • Phone: 206-349-4987
  • Fax:
Mailing address:
  • Phone: 206-349-4987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00021742
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: