Healthcare Provider Details

I. General information

NPI: 1992664650
Provider Name (Legal Business Name): CONNOR KNUCKLES LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2026
Last Update Date: 01/19/2026
Certification Date: 01/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5289 S WOODCREST DR
SALT LAKE CITY UT
84117-7434
US

IV. Provider business mailing address

5289 S WOODCREST DR
SALT LAKE CITY UT
84117-7434
US

V. Phone/Fax

Practice location:
  • Phone: 801-875-2087
  • Fax:
Mailing address:
  • Phone: 801-875-2087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number13536737-4701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: