Provider Demographics
NPI:1679307771
Name:RISING PHOENIX MASSAGE AND WELLNESS
Entity type:Organization
Organization Name:RISING PHOENIX MASSAGE AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADALYN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-814-4046
Mailing Address - Street 1:9221 S REDWOOD RD STE B
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-5803
Mailing Address - Country:US
Mailing Address - Phone:801-814-4046
Mailing Address - Fax:
Practice Address - Street 1:9221 S REDWOOD RD STE B
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-5803
Practice Address - Country:US
Practice Address - Phone:801-814-4046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty