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General NPI Number Information
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NPI Number | 1629746615
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Entity Type | Organization
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Legal Business Name | DYNAMIC HEALTH THERAPY
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Dates
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Enumeration Date | 09/02/2021
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Last Update Date | 09/02/2021
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Provider Practice Location Address
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Address Line | 1190 E 5425 S STE 210
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City | SOUTH OGDEN
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State | UT
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Zip | 84403-5194
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Country | US
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Telephone | 385-400-9193
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Fax |
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Provider Business Mailing Address
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Address Line | 1190 E 5425 S STE 210
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City | SOUTH OGDEN
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State | UT
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Zip | 84403-5194
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Country | US
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Telephone | 385-400-9193
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Fax |
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Authorized Official
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Title or Position | LICENSED MASSAGE THERAPIST/OWNER
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Name | LACY MAE JOHNSON
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Credential | LMT
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Telephone | 801-643-2303
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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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