Provider Demographics
NPI:1033752506
Name:EARL, AMBER (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:EARL
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 S 275 E
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-2174
Mailing Address - Country:US
Mailing Address - Phone:385-315-1019
Mailing Address - Fax:
Practice Address - Street 1:129 S STATE ST STE 170
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-1110
Practice Address - Country:US
Practice Address - Phone:801-948-0660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10780601-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist