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General NPI Number Information
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NPI Number | 1497106207
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Entity Type | Organization
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Legal Business Name | ELITE TRANQUILITY HEALTH SPA LLC
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Dates
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Enumeration Date | 06/23/2016
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Last Update Date | 06/23/2016
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Provider Practice Location Address
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Address Line | 726 E 12200 S SUITE E
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City | DRAPER
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State | UT
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Zip | 84020-9103
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Country | US
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Telephone | 801-495-9732
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Fax |
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Provider Business Mailing Address
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Address Line | 10437 S MILLERTON DR
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City | SOUTH JORDAN
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State | UT
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Zip | 84009-5733
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Country | US
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Telephone | 801-580-9031
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GREGORY LOVATO
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Credential |
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Telephone | 801-580-9031
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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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