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NPI Code Detail

MEDICARE: RACHEL PETERSON LMT

MEDICARE: RACHEL PETERSON 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
1225700000XMassage Therapist8431763-4701UT

General Provider Information

NPI Number : 1992279459
Entity Type Code : Individual
Provider Name (Legal Business Name) : RACHEL PETERSON LMT
Provider Business Mailing Address
First Line : 4578 S HIGHLAND DR STE 320
Second Line :
City : MILLCREEK
State : UT
Zip : 84117-4214
Country : US
Telephone Number : 801-833-8168
Fax Number :
Provider Business Practice Location Address
First Line : 4578 S HIGHLAND DR STE 320
Second Line :
City : MILLCREEK
State : UT
Zip : 84117-4214
Country : US
Telephone Number : 801-833-8168
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2019
Last Update Date : 01/17/2019

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