| NPI | 1104119957 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN M TAYLOR Credentialing Rep 801-505-0821 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy |
| Additional Taxonomies | 174400000X Specialist |
| Enumeration Date | 2011-05-25 |
| Last Update Date | 2017-01-26 |