Provider Demographics
NPI:1487194312
Name:NIHIPALI, STACY (LMT)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:
Last Name:NIHIPALI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:BLEGGI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:13552 S 110 W
Mailing Address - Street 2:STE 204
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-2401
Mailing Address - Country:US
Mailing Address - Phone:801-815-8929
Mailing Address - Fax:801-303-5040
Practice Address - Street 1:13552 S 110 W
Practice Address - Street 2:STE 204
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-2401
Practice Address - Country:US
Practice Address - Phone:801-815-8929
Practice Address - Fax:801-303-5040
Is Sole Proprietor?:No
Enumeration Date:2017-02-25
Last Update Date:2017-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT377499-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist