Provider Demographics
NPI:1942016241
Name:SOLANO JUDSON, ANTONIA LUCIA (LMT)
Entity type:Individual
Prefix:
First Name:ANTONIA
Middle Name:LUCIA
Last Name:SOLANO JUDSON
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 1:8237 W 3500 S
Mailing Address - Street 2:
Mailing Address - City:MAGNA
Mailing Address - State:UT
Mailing Address - Zip Code:84044-1851
Mailing Address - Country:US
Mailing Address - Phone:801-250-6319
Mailing Address - Fax:801-250-6092
Practice Address - Street 1:8237 W 3500 S
Practice Address - Street 2:
Practice Address - City:MAGNA
Practice Address - State:UT
Practice Address - Zip Code:84044-1851
Practice Address - Country:US
Practice Address - Phone:801-250-6319
Practice Address - Fax:801-250-6092
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14190395-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist