Provider Demographics
NPI:1962160721
Name:THOMPSON, KATHERIN (LMT)
Entity type:Individual
Prefix:
First Name:KATHERIN
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:KATHERIN
Other - Middle Name:
Other - Last Name:MINER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:7875 S CANDLESTICK LN APT 204
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-3275
Mailing Address - Country:US
Mailing Address - Phone:801-529-6315
Mailing Address - Fax:
Practice Address - Street 1:8734 S 700 E STE 250
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-1801
Practice Address - Country:US
Practice Address - Phone:801-529-6315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT213662-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist