Healthcare Provider Details

I. General information

NPI: 1023920600
Provider Name (Legal Business Name): TERI JOSEPHSON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2026
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6864 S LIZA LN
WEST JORDAN UT
84081-3441
US

IV. Provider business mailing address

6864 S LIZA LN
WEST JORDAN UT
84081-3441
US

V. Phone/Fax

Practice location:
  • Phone: 801-230-9173
  • Fax:
Mailing address:
  • Phone: 801-230-9173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7234756-4701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: