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General NPI Number Information
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NPI Number | 1770487399
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Entity Type | Individual
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Provider Name | LARRY BENJAMIN BOWEN
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Gender | Male
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Dates
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Enumeration Date | 10/06/2026
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Last Update Date | 10/06/2026
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Provider Practice Location Address
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Address Line | 3330 S 700 E # 128
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City | SALT LAKE CITY
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State | UT
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Zip | 84106-4684
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Country | US
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Telephone | 385-313-0153
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Fax |
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Provider Business Mailing Address
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Address Line | 2409 E KATIE LYNN LN
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City | HOLLADAY
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State | UT
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Zip | 84117-6252
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Country | US
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Telephone | 385-313-0153
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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 | 8137472-4701
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License Number State | UT
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