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General NPI Number Information
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NPI Number | 1619625464
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Entity Type | Individual
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Provider Name | JANA LEE WEAVER MASSAGE THERAPIST
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Gender | Female
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Dates
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Enumeration Date | 03/11/2022
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Last Update Date | 03/11/2022
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Provider Practice Location Address
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Address Line | 248 E TABERNACLE ST UNIT 300
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City | ST GEORGE
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State | UT
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Zip | 84770-2995
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Country | US
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Telephone | 435-881-0431
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Fax |
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Provider Business Mailing Address
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Address Line | 2367 S 2250 E
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City | ST GEORGE
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State | UT
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Zip | 84790-6248
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Country | US
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Telephone | 435-881-0431
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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 | 12096419-4701
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License Number State | UT
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