Provider Demographics
NPI:1376077669
Name:DEEP RECOVERY MASSAGE
Entity Type:Organization
Organization Name:DEEP RECOVERY MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRESHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-549-8799
Mailing Address - Street 1:4273 S 700 W
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:UT
Mailing Address - Zip Code:84405-3460
Mailing Address - Country:US
Mailing Address - Phone:801-549-8799
Mailing Address - Fax:
Practice Address - Street 1:6717 S 900 E STE 101
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-5755
Practice Address - Country:US
Practice Address - Phone:801-549-8799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT96417854701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty