Healthcare Provider Details

I. General information

NPI: 1861388415
Provider Name (Legal Business Name): PEDRO MANUEL FERNANDEZ LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2025
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
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

745 N 300 E # 745
SPANISH FORK UT
84660-1215
US

V. Phone/Fax

Practice location:
  • Phone: 385-831-1204
  • Fax:
Mailing address:
  • Phone: 435-695-6332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number14030890-4701
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: