Provider Demographics
NPI:1790530970
Name:SUNDWALL, KARLA JO (LMT)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:JO
Last Name:SUNDWALL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 W 75 N
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-8707
Mailing Address - Country:US
Mailing Address - Phone:801-458-1843
Mailing Address - Fax:
Practice Address - Street 1:1025 W 75 N
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-8707
Practice Address - Country:US
Practice Address - Phone:801-458-1843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-20
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT342630-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist