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General NPI Number Information
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NPI Number | 1003639667
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Entity Type | Organization
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Legal Business Name | ALIGN MASSAGE & WELLNESS LLC
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Dates
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Enumeration Date | 11/04/2024
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 620 24TH ST STE A
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City | OGDEN
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State | UT
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Zip | 84401-4322
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Country | US
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Telephone | 801-530-9851
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Fax |
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Provider Business Mailing Address
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Address Line | 671 33RD ST
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City | OGDEN
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State | UT
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Zip | 84403-0626
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Country | US
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Telephone | 801-530-9851
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Fax |
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Authorized Official
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Title or Position | CEO FOUNDER
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Name | MRS. BREANNE CAMILLE KILGROW
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Credential | LMT
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Telephone | 801-530-9851
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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