Provider Demographics
NPI:1518449529
Name:DENAM, GLORIA (MMT)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:DENAM
Suffix:
Gender:F
Credentials:MMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:667 ATLANTIS DR
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-4037
Mailing Address - Country:US
Mailing Address - Phone:801-800-6606
Mailing Address - Fax:
Practice Address - Street 1:4801 N UNIVERSITY AVE STE 15
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-5573
Practice Address - Country:US
Practice Address - Phone:385-323-0758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9363135-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist