=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871229963
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TERI THOMAS LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2022
-----------------------------------------------------
Last Update Date | 07/29/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 715 E 3900 S STE 107
-----------------------------------------------------
City | MILLCREEK
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84107-2566
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-870-3931
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1914 E GYRFALCON DR
-----------------------------------------------------
City | SANDY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84092-3930
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-598-3900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 7667904-4701
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------