Provider Demographics
NPI:1760204010
Name:CANCEL, SOL CONSUELO (LMT)
Entity type:Individual
Prefix:
First Name:SOL
Middle Name:CONSUELO
Last Name:CANCEL
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 1:5120 W CYCLAMEN WAY
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-3867
Mailing Address - Country:US
Mailing Address - Phone:801-706-9518
Mailing Address - Fax:
Practice Address - Street 1:5120 W CYCLAMEN WAY
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84081-3867
Practice Address - Country:US
Practice Address - Phone:801-706-9518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.023572225700000X
UT11631966-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist