Healthcare Provider Details

I. General information

NPI: 1750726840
Provider Name (Legal Business Name): HEBER JAMES BLACKNER LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2013
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

467 E 1000 S
PLEASANT GROVE UT
84062-3623
US

IV. Provider business mailing address

467 E 1000 S
PLEASANT GROVE UT
84062-3623
US

V. Phone/Fax

Practice location:
  • Phone: 801-623-9914
  • Fax:
Mailing address:
  • Phone: 801-623-9914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number338981-4701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: