Provider Demographics
NPI:1982858460
Name:PALMER'S MASSAGE LLC
Entity Type:Organization
Organization Name:PALMER'S MASSAGE LLC
Other - Org Name:PALMER'S CORPORATE MASSAGE LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:LICENSED MASSAGE THERAPIST/ OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:PALMER
Authorized Official - Last Name:PEDERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-830-4756
Mailing Address - Street 1:815 E 400 N
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-1611
Mailing Address - Country:US
Mailing Address - Phone:801-830-4756
Mailing Address - Fax:
Practice Address - Street 1:815 E 400 N
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-1611
Practice Address - Country:US
Practice Address - Phone:801-830-4756
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5274005-4701302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization