Individual
BRANDON BLACKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MHT
Contact information
Practice address
800 N 100 E, SPANISH FORK, UT 84660-5577
(801) 504-6125
Mailing address
800 N 100 E, SPANISH FORK, UT 84660-5577
(801) 504-6125
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
9353585-4701
UT
Other
Enumeration date
10/14/2017
Last updated
10/14/2017
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