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General NPI Number Information
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NPI Number | 1720946882
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Entity Type | Individual
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Provider Name | MADISON KEITH
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Gender | Female
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Dates
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Enumeration Date | 01/15/2026
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Last Update Date | 01/15/2026
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Provider Practice Location Address
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Address Line | 5471 EAST 2300 NORTH SUITE 1
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City | EDEN
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State | UT
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Zip | 84310
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Country | US
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Telephone | 801-745-3200
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Fax | 801-745-6115
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Provider Business Mailing Address
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Address Line | 1421 N 7275 E
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City | HUNTSVILLE
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State | UT
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Zip | 84317-9615
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Country | US
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Telephone | 801-745-3200
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Fax | 801-745-6115
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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 | 14238918-4701
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License Number State | UT
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