Provider Demographics
NPI:1871961433
Name:MATHIE, JANET LUNDBERG
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:LUNDBERG
Last Name:MATHIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1352 E GORDON AVE
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84040-2912
Mailing Address - Country:US
Mailing Address - Phone:801-644-6938
Mailing Address - Fax:
Practice Address - Street 1:1916 N 700 W STE 270
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-5755
Practice Address - Country:US
Practice Address - Phone:801-644-3938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6787338-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist