Provider Demographics
NPI:1720805310
Name:BLUTH, LAURA DENISE (LMT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:DENISE
Last Name:BLUTH
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 1:28 E 300 N APT 9
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-4648
Mailing Address - Country:US
Mailing Address - Phone:480-359-8056
Mailing Address - Fax:
Practice Address - Street 1:28 E 300 N APT 9
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-4648
Practice Address - Country:US
Practice Address - Phone:480-359-8056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14137579-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist