| NPI | 1760089049 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN D THOMPSON Manager 435-760-5896 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation |
| Additional Taxonomies | 111N00000X Chiropractor |
| 208VP0000X Pain Medicine, Pain Medicine | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2020-10-08 |
| Last Update Date | 2020-10-08 |