| NPI | 1588162283 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN MARIE TAYLOR Director Of Operations 801-505-0821 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: UT 336606-1205) |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: UT 9417126-1205) |
| 208100000X Physical Medicine & Rehabilitation | |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: UT 5336197-0501) | |
| Enumeration Date | 2018-01-28 |
| Last Update Date | 2018-03-17 |