Provider Demographics
NPI:1730570953
Name:GUTHRIE, MACY (LMT)
Entity type:Individual
Prefix:
First Name:MACY
Middle Name:
Last Name:GUTHRIE
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 1:130 S 900 E
Mailing Address - Street 2:APT 108
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-4138
Mailing Address - Country:US
Mailing Address - Phone:225-287-2592
Mailing Address - Fax:
Practice Address - Street 1:130 S 900 E
Practice Address - Street 2:#108
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-4138
Practice Address - Country:US
Practice Address - Phone:225-287-2592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-10
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9143710-4701225700000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator