Provider Demographics
NPI:1437555943
Name:PEDIATRIC MASSAGE
Entity Type:Organization
Organization Name:PEDIATRIC MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSE MASSAGE THERAPY
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:SCARTH
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:801-842-4230
Mailing Address - Street 1:3493 W DANUBE DR
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84129-7869
Mailing Address - Country:US
Mailing Address - Phone:801-842-4230
Mailing Address - Fax:
Practice Address - Street 1:3493 W DANUBE DR
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84129-7869
Practice Address - Country:US
Practice Address - Phone:801-842-4230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8782720-4701305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service