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General NPI Number Information
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NPI Number | 1811561558
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Entity Type | Individual
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Provider Name | OMAR BARAY
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Gender | Male
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Dates
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Enumeration Date | 05/17/2021
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Last Update Date | 06/22/2021
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Provider Practice Location Address
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Address Line | 789 E BAMBERGER DR STE C
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City | AMERICAN FORK
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State | UT
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Zip | 84003-2183
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Country | US
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Telephone | 801-692-3216
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Fax |
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Provider Business Mailing Address
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Address Line | 4135 E SUN CREST DR
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City | EAGLE MOUNTAIN
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State | UT
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Zip | 84005-5269
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Country | US
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Telephone | 860-558-1634
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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 | 5757647-4701
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License Number State | UT
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