Provider Demographics
NPI:1871031062
Name:FAGER, LAURA (LMT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:FAGER
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 1:4716 QUICKDRAW LN
Mailing Address - Street 2:
Mailing Address - City:ENOCH
Mailing Address - State:UT
Mailing Address - Zip Code:84721-7462
Mailing Address - Country:US
Mailing Address - Phone:801-706-2787
Mailing Address - Fax:
Practice Address - Street 1:2113 N MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84721-7763
Practice Address - Country:US
Practice Address - Phone:435-862-8929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9177381-4701172M00000X, 173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
No173C00000XOther Service ProvidersReflexologist