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General NPI Number Information
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NPI Number | 1942887484
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Entity Type | Individual
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Provider Name | RICHARD MERRILL LMT
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Gender | Male
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Dates
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Enumeration Date | 03/29/2021
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Last Update Date | 03/29/2021
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Provider Practice Location Address
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Address Line | 1054 E 3900 S
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City | MILLCREEK
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State | UT
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Zip | 84124-1138
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Country | US
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Telephone | 801-268-3900
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Fax |
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Provider Business Mailing Address
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Address Line | 8242 S SHANGRILA CIR
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City | SANDY
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State | UT
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Zip | 84094-1322
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Country | US
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Telephone | 801-680-2269
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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 | 110971-4701
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License Number State | UT
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