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General NPI Number Information
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NPI Number | 1023830841
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Entity Type | Individual
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Provider Name | MATTHEW BEACH
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Gender | Male
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Dates
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Enumeration Date | 10/31/2024
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 1787 E FORT UNION BLVD STE 101
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City | COTTONWOOD HEIGHTS
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State | UT
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Zip | 84121-2868
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Country | US
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Telephone | 385-526-3945
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Fax |
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Provider Business Mailing Address
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Address Line | 1300 HOBBLE CREEK DR
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City | SPRINGVILLE
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State | UT
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Zip | 84663-2854
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Country | US
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Telephone | 801-703-7536
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 8052147-4701
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 8052147-2402
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License Number State | UT
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