=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487589370
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JODIE GORNEY LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2026
-----------------------------------------------------
Last Update Date | 06/15/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4885 S 900 E STE 204
-----------------------------------------------------
City | MURRAY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84117-5746
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 385-831-1204
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2789 W 2935 S
-----------------------------------------------------
City | WEST VALLEY CITY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84119-1844
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
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 | 6436316-4701
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------