Individual
MADISON HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
29 S MAIN ST, TOOELE, UT 84074-2158
(435) 843-7466
Mailing address
PO BOX 711185, SALT LAKE CITY, UT 84171-1185
(801) 942-3311
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10208378-4701
UTAH STATE LICENSE
UT
Enumeration date
01/13/2020
Last updated
01/13/2020
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