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General NPI Number Information
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NPI Number | 1336699453
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Entity Type | Individual
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Provider Name | SHEA GIFFORD LMT
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Gender | Male
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Dates
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Enumeration Date | 10/12/2016
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Last Update Date | 02/26/2023
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Provider Practice Location Address
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Address Line | 193 E FORT UNION BLVD STE 203
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City | MIDVALE
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State | UT
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Zip | 84047-5543
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Country | US
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Telephone | 435-592-3475
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Fax |
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Provider Business Mailing Address
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Address Line | 1488 WESTBURY WAY APT H
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City | LEHI
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State | UT
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Zip | 84043-4907
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Country | US
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Telephone | 435-592-3475
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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 | MAS-2844
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 8269416-4701
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License Number State | UT
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