Provider Demographics
NPI:1578282083
Name:WESTSIDE THERAPEUTIC MASSAGE
Entity Type:Organization
Organization Name:WESTSIDE THERAPEUTIC MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:801-784-5777
Mailing Address - Street 1:1407 NORTH 2000 WEST SUITE J
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:UT
Mailing Address - Zip Code:84015-8562
Mailing Address - Country:US
Mailing Address - Phone:801-784-5777
Mailing Address - Fax:801-784-5778
Practice Address - Street 1:1407 NORTH 2000 WEST SUITE J
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:UT
Practice Address - Zip Code:84015-8562
Practice Address - Country:US
Practice Address - Phone:801-784-5777
Practice Address - Fax:801-784-5778
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTSIDE THERAPEUTIC MASSAGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty