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General NPI Number Information
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NPI Number | 1467130138
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Entity Type | Individual
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Provider Name | JESSE MOFFAT MALAN LMT, MMP
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Gender | Male
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Dates
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Enumeration Date | 07/11/2023
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Last Update Date | 07/11/2023
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Provider Practice Location Address
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Address Line | 169 W 2710 SOUTH CIR
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City | ST GEORGE
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State | UT
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Zip | 84790-7201
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Country | US
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Telephone | 435-609-9617
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Fax |
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Provider Business Mailing Address
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Address Line | 265 N DIXIE DR UNIT 86
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City | ST GEORGE
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State | UT
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Zip | 84770-6189
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Country | US
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Telephone | 435-630-3452
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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 | 7907321-4701
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License Number State | UT
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