Provider Demographics
NPI:1619625464
Name:WEAVER, JANA LEE (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:LEE
Last Name:WEAVER
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2367 S 2250 E
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-6248
Mailing Address - Country:US
Mailing Address - Phone:435-881-0431
Mailing Address - Fax:
Practice Address - Street 1:248 E TABERNACLE ST
Practice Address - Street 2:UNIT 300
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-2995
Practice Address - Country:US
Practice Address - Phone:435-881-0431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12096419-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist