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General NPI Number Information
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NPI Number | 1851192587
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Entity Type | Individual
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Provider Name | LAURA B CREEKMORE
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Gender | Female
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Dates
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Enumeration Date | 03/19/2025
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 2077 N 200 E
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City | NORTH LOGAN
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State | UT
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Zip | 84341-5505
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Country | US
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Telephone | 435-554-1241
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Fax |
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Provider Business Mailing Address
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Address Line | 744 W 400 N UNIT J306
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City | LOGAN
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State | UT
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Zip | 84321-7096
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Country | US
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Telephone |
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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 | 13748477-4701
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License Number State | UT
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