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General NPI Number Information
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NPI Number | 1487300562
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Entity Type | Organization
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Legal Business Name | PENDER ATHLETIC BRANDS, INC.
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Dates
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Enumeration Date | 02/26/2022
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Last Update Date | 02/26/2022
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Provider Practice Location Address
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Address Line | 250 RED CLIFFS DR STE 36
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City | ST GEORGE
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State | UT
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Zip | 84790-8129
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Country | US
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Telephone | 540-300-2626
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Fax |
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Provider Business Mailing Address
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Address Line | 1822 N HABITAT DR
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City | WASHINGTON
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State | UT
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Zip | 84780-1366
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Country | US
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Telephone | 931-896-3234
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JASON PENDER
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Credential |
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Telephone | 931-896-3234
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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 |
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License Number State |
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