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Individual

SHEA GIFFORD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LMT

Contact information

Practice address
193 E FORT UNION BLVD STE 203, MIDVALE, UT 84047-5543
(435) 592-3475
Mailing address
1488 WESTBURY WAY APT H, LEHI, UT 84043-4907
(435) 592-3475

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
8269416-4701
UT
225700000X
Massage Therapist
MAS-2844
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
8269416-4701
STATE LICENSE
UT
01
MAS-2844
STATE LICENSE
ID
Enumeration date
10/12/2016
Last updated
02/26/2023
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