Provider Demographics
NPI:1962150425
Name:PAUL AND TASHA MASSAGE LLC
Entity type:Organization
Organization Name:PAUL AND TASHA MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:OUDERKIRK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-855-5834
Mailing Address - Street 1:366 S 500 E STE B
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2526
Mailing Address - Country:US
Mailing Address - Phone:801-855-5834
Mailing Address - Fax:
Practice Address - Street 1:366 S 500 E STE B
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2526
Practice Address - Country:US
Practice Address - Phone:801-855-5834
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-14
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty