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General NPI Number Information
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NPI Number | 1407100639
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Entity Type | Organization
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Legal Business Name | THERAPEUTIC MASSAGE & BODYWORK LLC
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Dates
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Enumeration Date | 11/09/2012
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Last Update Date | 12/07/2023
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Provider Practice Location Address
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Address Line | 904 S MAIN ST
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-3560
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Country | US
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Telephone | 801-687-3957
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Fax |
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Provider Business Mailing Address
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Address Line | 904 S MAIN ST
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-3560
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Country | US
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Telephone | 801-687-3957
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TIFFANY C JACKSON
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Credential | LMT
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Telephone | 801-687-3957
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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 | 6077621-4701
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License Number State | UT
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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 | 8407908-4701
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License Number State | UT
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Taxonomy #3
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 5370898-1202
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License Number State | UT
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