Provider Demographics
NPI:1528891553
Name:BIRD, JESSICA (LMT, MBA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BIRD
Suffix:
Gender:F
Credentials:LMT, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3098 W 525 N
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:UT
Mailing Address - Zip Code:84015-7437
Mailing Address - Country:US
Mailing Address - Phone:480-432-6367
Mailing Address - Fax:
Practice Address - Street 1:579 HERITAGE PARK BLVD STE 223
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-5721
Practice Address - Country:US
Practice Address - Phone:480-432-6367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11499140-4701172M00000X, 173C00000X, 208VP0000X, 226300000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No172M00000XOther Service ProvidersMechanotherapistGroup - Multi-Specialty
No173C00000XOther Service ProvidersReflexologist
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist