| NPI | 1659748952 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEVI BERRY Owner 801-609-4743 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: UT 93570600501) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: UT 93570600501) |
| Enumeration Date | 2015-08-22 |
| Last Update Date | 2016-12-19 |