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General NPI Number Information
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NPI Number | 1518449529
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Entity Type | Individual
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Provider Name | GLORIA DENAM MMT
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Gender | Female
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Dates
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Enumeration Date | 09/05/2018
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Last Update Date | 09/05/2018
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Provider Practice Location Address
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Address Line | 4801 N UNIVERSITY AVE STE 15
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City | PROVO
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State | UT
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Zip | 84604-5573
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Country | US
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Telephone | 385-323-0758
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Fax |
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Provider Business Mailing Address
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Address Line | 667 ATLANTIS DR
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City | OREM
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State | UT
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Zip | 84057-4037
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Country | US
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Telephone | 801-800-6606
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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 | 9363135-4701
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License Number State | UT
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