Healthcare Provider Details

I. General information

NPI: 1578100335
Provider Name (Legal Business Name): LORI BERRYHILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2019
Last Update Date: 11/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 E 7TH AVE
SALT LAKE CITY UT
84103-3555
US

IV. Provider business mailing address

670 E 7TH AVE
SALT LAKE CITY UT
84103-3555
US

V. Phone/Fax

Practice location:
  • Phone: 801-355-3076
  • Fax:
Mailing address:
  • Phone: 801-355-3076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number6635770-1201
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: