| NPI | 1730630203 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIKE ODOM Program Administrator 801-233-8670 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR0401X Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) (Licence: UT 22529) |
| Enumeration Date | 2016-10-20 |
| Last Update Date | 2016-10-20 |