Healthcare Provider Details

I. General information

NPI: 1538945274
Provider Name (Legal Business Name): CARLY SKOWRON PHD, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RAVI AVIANA PHD, LMT

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 E 4800 S STE 210
SALT LAKE CITY UT
84107-5533
US

IV. Provider business mailing address

893 S 830 E
OREM UT
84097-4702
US

V. Phone/Fax

Practice location:
  • Phone: 512-202-4737
  • Fax:
Mailing address:
  • Phone: 512-202-4737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number6840702-4701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: