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General NPI Number Information
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NPI Number | 1114570280
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Entity Type | Organization
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Legal Business Name | NIVATI INC
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Dates
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Enumeration Date | 07/18/2019
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Last Update Date | 09/28/2022
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Provider Practice Location Address
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Address Line | 10808 S RIVER FRONT PKWY STE 3054
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-5759
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Country | US
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Telephone | 800-556-2950
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Fax |
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Provider Business Mailing Address
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Address Line | 10808 S RIVER FRONT PKWY STE 3054
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-5759
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | AMELIA WILCOX
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Credential |
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Telephone | 801-891-3192
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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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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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