Provider Demographics
NPI:1578179768
Name:JARVIES, LANDON OTTO (LMT)
Entity Type:Individual
Prefix:
First Name:LANDON
Middle Name:OTTO
Last Name:JARVIES
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2254 W 325 S
Mailing Address - Street 2:
Mailing Address - City:MAPLETON
Mailing Address - State:UT
Mailing Address - Zip Code:84664-4312
Mailing Address - Country:US
Mailing Address - Phone:385-216-2382
Mailing Address - Fax:
Practice Address - Street 1:2254 W 325 S
Practice Address - Street 2:
Practice Address - City:MAPLETON
Practice Address - State:UT
Practice Address - Zip Code:84664-4312
Practice Address - Country:US
Practice Address - Phone:385-216-2382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT154418225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty