Organization
TOTAL THETA WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARTHA SOUTHWICK FNP-BC (OWNER)
(801) 943-3373
Entity
Organization
Contact information
Practice address
8789 S HIGHLAND DR, SUITE 200, SANDY, UT 84093-1600
(801) 943-3373
(801) 943-0599
Mailing address
8789 S HIGHLAND DR, SUITE 200, SANDY, UT 84093-1600
(801) 943-3373
(801) 943-0599
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
200020-4405
UT
Other
Enumeration date
11/15/2013
Last updated
02/19/2014
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