Provider Demographics
NPI:1538945274
Name:SKOWRON, CARLY (PHD, LMT)
Entity type:Individual
Prefix:DR
First Name:CARLY
Middle Name:
Last Name:SKOWRON
Suffix:
Gender:F
Credentials:PHD, LMT
Other - Prefix:DR
Other - First Name:RAVI
Other - Middle Name:
Other - Last Name:AVIANA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, LMT
Mailing Address - Street 1:893 S 830 E
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-4702
Mailing Address - Country:US
Mailing Address - Phone:512-202-4737
Mailing Address - Fax:
Practice Address - Street 1:835 E 4800 S STE 210
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-5533
Practice Address - Country:US
Practice Address - Phone:512-202-4737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6840702-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist