Healthcare Provider Details

I. General information

NPI: 1134074107
Provider Name (Legal Business Name): JONATHAN CUNNIFFE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1893 E SKYLINE DR STE 104
OGDEN UT
84403-5296
US

IV. Provider business mailing address

1893 E SKYLINE DR STE 104
OGDEN UT
84403-5296
US

V. Phone/Fax

Practice location:
  • Phone: 626-543-4916
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number14284537-4701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: