Healthcare Provider Details

I. General information

NPI: 1164356382
Provider Name (Legal Business Name): BRIDGET PACHECO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
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

578 E 5400 S
MURRAY UT
84107-6829
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number8845456-4701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: