MEDICARE: MRS. TERAH KAY CORNISH LMT

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	9657703-4701	UT

General Provider Information

NPI Number	:	1649046301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TERAH KAY CORNISH LMT

Provider Business Mailing Address
First Line	:	2037 W SPRUCE CREEK LN # B
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84095-2409
Country	:	US
Telephone Number	:	385-479-0433
Fax Number	:

Provider Business Practice Location Address
First Line	:	4568 S HIGHLAND DR STE 150
Second Line	:
City	:	MILLCREEK
State	:	UT
Zip	:	84117-4242
Country	:	US
Telephone Number	:	385-479-0433
Fax Number	:

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

Provider Enumeration Date	:	12/04/2023
Last Update Date	:	12/04/2023

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