=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205799905
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIMBERLY OWENS LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2025
-----------------------------------------------------
Last Update Date | 12/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 360 S FORT LN # B-106
-----------------------------------------------------
City | LAYTON
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84041-4259
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-725-7985
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 652 W 800 N APT 124
-----------------------------------------------------
City | CLINTON
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84015-9478
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-725-7985
-----------------------------------------------------
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 | 359642-4701
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------