Individual
DONAVAN LEWIS TERRANOVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
6735 W 10050 N, HIGHLAND, UT 84003-9211
(801) 669-3963
Mailing address
6735 W 10050 N, HIGHLAND, UT 84003-9211
(801) 669-3963
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
10295688-4701
UT
Other
Enumeration date
07/12/2018
Last updated
07/12/2018
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