Healthcare Provider Details

I. General information

NPI: 1144044850
Provider Name (Legal Business Name): SHEVONN JOHNSON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2024
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 W 9000 S STE 104
SANDY UT
84070-2008
US

IV. Provider business mailing address

57 W 9000 S STE 104
SANDY UT
84070-2008
US

V. Phone/Fax

Practice location:
  • Phone: 385-722-4431
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number14185005-4701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: