Healthcare Provider Details

I. General information

NPI: 1447142484
Provider Name (Legal Business Name): BRIDGETTE GONZALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9221 S REDWOOD RD STE B
WEST JORDAN UT
84088-5803
US

IV. Provider business mailing address

172 W HARRISON ST APT 1204
SANDY UT
84070-1859
US

V. Phone/Fax

Practice location:
  • Phone: 801-949-4449
  • Fax: 801-972-0510
Mailing address:
  • Phone: 801-949-4449
  • Fax: 801-972-0510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number1861227589
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number14232040-4701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: