Healthcare Provider Details

I. General information

NPI: 1245188283
Provider Name (Legal Business Name): ALYSSA SHROUT LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALYSSA APOSTOL LMT

II. Dates (important events)

Enumeration Date: 03/17/2026
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1664 S DIXIE DR STE L104
SAINT GEORGE UT
84770-7331
US

IV. Provider business mailing address

1664 S DIXIE DR STE L104
SAINT GEORGE UT
84770-7331
US

V. Phone/Fax

Practice location:
  • Phone: 435-668-8977
  • Fax: 435-222-2118
Mailing address:
  • Phone: 435-668-8977
  • Fax: 435-222-2118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number5873045-4701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: