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General NPI Number Information
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NPI Number | 1578382248
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Entity Type | Individual
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Provider Name | TAI LY
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Gender | Male
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Dates
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Enumeration Date | 10/09/2024
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 4885 S 900 E STE 230E
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City | MURRAY
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State | UT
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Zip | 84117-3939
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Country | US
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Telephone | 385-492-6841
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Fax |
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Provider Business Mailing Address
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Address Line | 682 ORCHARD DR.
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City | BOUNTIFUL
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State | UT
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Zip | 84010-5018
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Country | US
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Telephone | 385-503-6415
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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 | 9067727-4701
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License Number State | UT
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