Individual
HEATHER DIANE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1692 E 1030 N, LOGAN, UT 84341-3006
(435) 994-1669
(435) 797-1248
Mailing address
1692 E 1030 N, LOGAN, UT 84341-3006
(435) 994-1669
(435) 797-1248
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
507805-06
IL
225700000X
Massage Therapist
Primary
6477960-4701
UT
225700000X
Massage Therapist
MT-09592
AZ
225700000X
Massage Therapist
MT019872
TX
Other
Enumeration date
05/26/2010
Last updated
05/26/2010
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