Provider Demographics
NPI:1215149869
Name:HOSTETLER, CAMI JO (LMT)
Entity type:Individual
Prefix:
First Name:CAMI
Middle Name:JO
Last Name:HOSTETLER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 E WATERSIDE CV APT 21
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-4280
Mailing Address - Country:US
Mailing Address - Phone:425-345-5430
Mailing Address - Fax:
Practice Address - Street 1:7301 S 900 E STE 12
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-4498
Practice Address - Country:US
Practice Address - Phone:425-345-5430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12564964-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0288532OtherL & I
WA0288543OtherL & I