MEDICARE: NATHAN MORONI CLAY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	14104587-4701	UT

General Provider Information

NPI Number	:	1548083025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHAN MORONI CLAY

Provider Business Mailing Address
First Line	:	PO BOX 745
Second Line	:
City	:	MOUNTAIN GRV
State	:	MO
Zip	:	65711-0745
Country	:	US
Telephone Number	:	484-477-8866
Fax Number	:

Provider Business Practice Location Address
First Line	:	1425 W 2280 S
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84119-1413
Country	:	US
Telephone Number	:	484-477-8866
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2024
Last Update Date	:	11/04/2024

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