| NPI | 1356161970 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRENTON N POULSON Managing Member/Owner 801-369-5619 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy |
| Enumeration Date | 2024-10-17 |
| Last Update Date | 2024-10-17 |