Healthcare Provider Details

I. General information

NPI: 1366381154
Provider Name (Legal Business Name): REBECCA CAMPOS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

732 WEST RIVERDALE ROAD
RIVERDALE UT
84405
US

IV. Provider business mailing address

1437 N LIBERTY AVE
OGDEN UT
84404-3307
US

V. Phone/Fax

Practice location:
  • Phone: 801-624-8327
  • Fax:
Mailing address:
  • Phone: 801-624-8327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number9067638-4701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: