Healthcare Provider Details

I. General information

NPI: 1346152576
Provider Name (Legal Business Name): JODI SPACKMAN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 E EXECUTIVE PARK DR STE C
MURRAY UT
84117-3549
US

IV. Provider business mailing address

1068 CRESCENT DR
LOGAN UT
84341-2414
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number366542-4701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: