=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184029142
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMILY CARTER LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2014
-----------------------------------------------------
Last Update Date | 11/01/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 904 S MAIN ST
-----------------------------------------------------
City | PLEASANT GROVE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84062-3560
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-309-1404
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 904 S MAIN ST
-----------------------------------------------------
City | PLEASANT GROVE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84062-3560
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-309-1404
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 7379840-4701
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------