Healthcare Provider Details

I. General information

NPI: 1962332064
Provider Name (Legal Business Name): SOFIA TERRETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2348 KIESEL AVE
OGDEN UT
84401-1964
US

IV. Provider business mailing address

2348 KIESEL AVE
OGDEN UT
84401-1964
US

V. Phone/Fax

Practice location:
  • Phone: 801-528-5066
  • Fax:
Mailing address:
  • Phone: 801-528-5066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number142796264701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: