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General NPI Number Information
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NPI Number | 1578952966
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Entity Type | Organization
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Legal Business Name | THE MASSAGE BOUTIQUE
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Dates
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Enumeration Date | 01/22/2015
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Last Update Date | 01/22/2015
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Provider Practice Location Address
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Address Line | 12 W 100 N 202C
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City | AMERICAN FORK
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State | UT
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Zip | 84003-1611
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Country | US
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Telephone | 801-906-3270
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Fax |
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Provider Business Mailing Address
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Address Line | 12 W 100 N 202C
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City | AMERICAN FORK
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State | UT
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Zip | 84003
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Country | US
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Telephone | 801-906-3270
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MISS MARIAN GAPPMAYER SHARP
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Credential | L.M.T.
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Telephone | 801-228-7634
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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 | 7875506-4701
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License Number State | UT
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