Provider Demographics
NPI:1265189120
Name:FASCIAL THERAPIES
Entity type:Organization
Organization Name:FASCIAL THERAPIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HERVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-452-8007
Mailing Address - Street 1:1401 N 1075 W
Mailing Address - Street 2:STE 220
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025
Mailing Address - Country:US
Mailing Address - Phone:801-452-8007
Mailing Address - Fax:
Practice Address - Street 1:1401 N 1075 W STE 220
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-2745
Practice Address - Country:US
Practice Address - Phone:385-244-8060
Practice Address - Fax:385-422-8990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty