Provider Demographics
NPI:1891231320
Name:DANIELL, REBECCA E (LMT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:E
Last Name:DANIELL
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 1:3772 S CARLISLE PARK PL
Mailing Address - Street 2:UNIT 1
Mailing Address - City:SOUTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84119-7818
Mailing Address - Country:US
Mailing Address - Phone:801-201-3501
Mailing Address - Fax:
Practice Address - Street 1:3772 S CARLISLE PARK PL
Practice Address - Street 2:UNIT 1
Practice Address - City:SOUTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84119-7818
Practice Address - Country:US
Practice Address - Phone:801-201-3501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-08
Last Update Date:2017-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9007695-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist