Healthcare Provider Details

I. General information

NPI: 1356195465
Provider Name (Legal Business Name): AMMON HARDIN MASSAGE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 10/11/2026
Certification Date: 10/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4885 S 900 E STE 204
MURRAY UT
84117-5746
US

IV. Provider business mailing address

6807 S NORMANDY PL
MIDVALE UT
84047-1435
US

V. Phone/Fax

Practice location:
  • Phone: 385-831-1204
  • Fax: 877-283-3682
Mailing address:
  • Phone: 385-831-1204
  • Fax: 877-283-3682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: AMMON HARDIN
Title or Position: OWNER
Credential: LMT
Phone: 385-831-1204