Healthcare Provider Details

I. General information

NPI: 1417828971
Provider Name (Legal Business Name): BODY RENAISSANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2025
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 S MAIN ST
PAYSON UT
84651-2223
US

IV. Provider business mailing address

742 N 350 E
GENOLA UT
84655-8326
US

V. Phone/Fax

Practice location:
  • Phone: 385-501-1999
  • Fax: 801-206-3338
Mailing address:
  • Phone: 385-510-5282
  • Fax: 801-206-3338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KARL F STEMMLER
Title or Position: CREDENTIALING DIRECTOR
Credential: MPA
Phone: 619-258-6200