Healthcare Provider Details

I. General information

NPI: 1467385633
Provider Name (Legal Business Name): MICHELLE BERNAL SALDIVAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHELLY BERNAL

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 E 860 S
OREM UT
84058-5013
US

IV. Provider business mailing address

276 S 900 W
PROVO UT
84601-4016
US

V. Phone/Fax

Practice location:
  • Phone: 801-800-3587
  • Fax:
Mailing address:
  • Phone: 801-800-3587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number11921644-4701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: