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General NPI Number Information
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NPI Number | 1740783091
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Entity Type | Individual
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Provider Name | GARY WAYNE FOSS LMT
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Gender | Male
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Dates
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Enumeration Date | 03/13/2018
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1153 E 3900 S
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City | MILLCREEK
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State | UT
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Zip | 84124-1201
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Country | US
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Telephone | 801-262-6331
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Fax |
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Provider Business Mailing Address
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Address Line | 1952 E FT UNION BLVD
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City | SALT LAKE CITY
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State | UT
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Zip | 84121-6877
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Country | US
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Telephone | 801-495-5234
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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 | 5029464-4701
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License Number State | UT
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