Individual
ANGEL GLADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4782 S HOLLADAY BLVD, HOLLADAY, UT 84117-5444
(385) 465-9002
Mailing address
4782 S HOLLADAY BLVD, HOLLADAY, UT 84117-5444
(385) 465-9002
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
13325087-4003
UT
Other
Enumeration date
04/18/2024
Last updated
04/18/2024
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