| NPI | 1740843697 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JARED TINGEY Registered Agent 801-540-9869 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM |
| Additional Taxonomies | 2251N0400X Physical Therapist Neurology |
| 363LF0000X Nurse Practitioner Family | |
| Enumeration Date | 2019-04-17 |
| Last Update Date | 2019-04-17 |