Provider Demographics
NPI:1063122042
Name:CRADLE YOUR SOUL YOGA AND MASSAGE
Entity type:Organization
Organization Name:CRADLE YOUR SOUL YOGA AND MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLY
Authorized Official - Middle Name:D
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:801-244-8164
Mailing Address - Street 1:196 W 12300 S STE 105
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-8090
Mailing Address - Country:US
Mailing Address - Phone:801-557-9888
Mailing Address - Fax:
Practice Address - Street 1:196 W 12300 S STE 105
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-8090
Practice Address - Country:US
Practice Address - Phone:801-557-9888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-30
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care