| NPI | 1508079310 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY D JOHNSON Owner 801-879-4982 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: UT 268117-0501) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2012-07-29 |