Individual
LACY MAE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MASSAGE THERAPIST
Contact information
Practice address
1190 E 5425 S STE 210, SOUTH OGDEN, UT 84403-5194
(385) 400-9193
Mailing address
1190 E 5425 S STE 210, SOUTH OGDEN, UT 84403-5194
(385) 400-9193
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
9199023-4701
UT
Other
Enumeration date
09/02/2021
Last updated
09/02/2021
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