Provider Demographics
NPI:1871229963
Name:THOMAS, TERI (LMT)
Entity type:Individual
Prefix:
First Name:TERI
Middle Name:
Last Name:THOMAS
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 1:1914 E GYRFALCON DR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-3930
Mailing Address - Country:US
Mailing Address - Phone:801-598-3900
Mailing Address - Fax:
Practice Address - Street 1:715 E 3900 S STE 107
Practice Address - Street 2:
Practice Address - City:MILLCREEK
Practice Address - State:UT
Practice Address - Zip Code:84107-2566
Practice Address - Country:US
Practice Address - Phone:801-870-3931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7667904-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist