Provider Demographics
NPI:1720652746
Name:GILLINGHAM, HELEENA SARA ANN (BSYA REFLEX, LMT, RM)
Entity Type:Individual
Prefix:MS
First Name:HELEENA
Middle Name:SARA ANN
Last Name:GILLINGHAM
Suffix:
Gender:F
Credentials:BSYA REFLEX, LMT, RM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2869 HICKORY WAY
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-6912
Mailing Address - Country:US
Mailing Address - Phone:435-313-3469
Mailing Address - Fax:
Practice Address - Street 1:2869 HICKORY WAY
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-6912
Practice Address - Country:US
Practice Address - Phone:435-313-3469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10549149-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty