Individual
DANIEL BANTA ETHINGTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
9317 S TANYA AVE, WEST JORDAN, UT 84088-8529
(801) 244-3384
Mailing address
9317 S TANYA AVE, WEST JORDAN, UT 84088-8529
(801) 244-3384
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
108638114701
UT
Other
Enumeration date
07/05/2018
Last updated
07/05/2018
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