Healthcare Provider Details

I. General information

NPI: 1154795474
Provider Name (Legal Business Name): KATHERINE HELLER L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2015
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6112 S 1550 E STE 203
SOUTH OGDEN UT
84405-5010
US

IV. Provider business mailing address

6112 S 1550 E STE 203
SOUTH OGDEN UT
84405-5010
US

V. Phone/Fax

Practice location:
  • Phone: 801-897-8711
  • Fax:
Mailing address:
  • Phone: 801-897-8711
  • Fax: 385-333-7202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number10712283-4701
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: