Provider Demographics
NPI:1063026573
Name:THOMAS, EVELYN (LMT)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6166 W 8010 S
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-4322
Mailing Address - Country:US
Mailing Address - Phone:801-859-1377
Mailing Address - Fax:
Practice Address - Street 1:891 W BAXTER DR
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-8506
Practice Address - Country:US
Practice Address - Phone:801-859-1377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-02
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9374296-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist