Individual
MICHEAL BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.M.T.
Contact information
Practice address
10358 S REDWOOD RD, SOUTH JORDAN, UT 84095-9339
(801) 253-3158
(801) 254-5739
Mailing address
10358 S REDWOOD RD, SOUTH JORDAN, UT 84095-9339
(801) 253-3158
(801) 254-5739
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
261943-4701
UT
Other
Enumeration date
03/05/2007
Last updated
07/08/2007
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