| NPI | 1053175976 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH FYANS Owner 801-475-5254 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2024-02-12 |
| Last Update Date | 2024-06-07 |