Individual
BRYAN FONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
5258 S PINEMONT DR # B-105, MURRAY, UT 84123-4614
(801) 639-0444
Mailing address
5258 S PINEMONT DR # B-105, MURRAY, UT 84123-4614
(801) 639-0444
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
123378-4701
UT
Other
Enumeration date
03/05/2013
Last updated
03/05/2013
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